Efficacy of Compression Sutures in Controlling Excessive Uterine Bleeding During Caesarean Section
Condition: Bleeding in Cesarean Section
MeSH terms: Uterine Hemorrhage; Hemorrhage
Study type: Interventional

Summary: 
      The investigators found that B- Lynch suture is more effective than Nausicca suture in
      controlling excessive uterine bleeding during cesarean section and avoiding the need of
      hysterectomy.

      Also, the investigators found that B- lynch suture needs shorter procedure time with less
      blood loss compared to Nausicca suture.

      Consequently the investigators recommend the use of B-Lynch suture as a compressive uterine
      suture to control excessive uterine bleeding during cesarean section and avoid the need of
      hysterectomy.

      As a result of this study the investigators recommend further studies to compare different
      uterine compressive suture to verify the most effective uterine compressive suture.
    

Detailed description: 
      The objective of this study is to compare the efficacy of Nausicaa suture and B -lynch suture
      in controlling excessive uterine bleeding during cesarean section and avoiding the need for
      hystserctomy.

      The investigators established this randomized controlled trial on participants with excessive
      uterine bleeding during cesarean section not responding to uterine massage and ecbolics in
      obstetric operative theatre in Ain Shams Maternity Hospitals.

      During cesarean section, sixty participants who suffered from excessive uterine bleeding
      during cesarean section and not responding to uterine massage and ecbolics and who are
      willing to participate in the study and gave informed consent had Nausicaa or B-Lynch uterine
      compressive suture after randomizations using opaque sealed envelopes.

      The selection of the type of suture done after allocation of women into two groups as llows:

      Group (A):

      Participants allocated in this group will have Nausicca suture done. Nausicaa suture will be
      applied by using round bodied, 3/8 circle curved needle, 70mm with 2-metric polyglactan
      suture. Suturing will be done by needle transfixing from the uterine serosa lateral to the
      bleeding area (or invaded myometrium) inside the uterine cavity. The needle will then be
      threaded along a horizontal course inside the uterine cavity until it encompassed the
      bleeding area, finally emerges at the other side of the uterine serosa. The sutures
      penetrated the full thickness of the myometrium without stitching the anterior and posterior
      walls together. Care will be taken to avoid transfixing any engorged parametrial vessels. A
      flat surgical knot will be then tied as tightly as possible above the serosa. Using these
      healthy myometrium as the anchoring points for needle transfixation, we will not encounter
      tissue destruction by the ligature. To achieve a better compression effect, the assistant
      often needed to clench the sutured myometrium while the operator ties off the knots.
      Additional sutures will made approximately 1.5-2 cm parallel to the previous stitches until
      haemostasis is achieved.

      Group (B):

      Participants allocated in this group will have B- lynch suture done. B-Lynch suture will be
      applied by using round bodied, 3/8 circle curved needle, 70mm with 2-metric polyglactan
      suture. Suturing will done according to method described by B-lynch et al. (1997) by starting
      in the uterus 3 cm from the right lower edge of the uterine incision and 3 cm from the right
      lateral border then passes through the uterine cavity to emerge at the upper incision margin
      3 cm above and approximately 4 cm from the lateral border (because the uterus widens from
      below upwards), It will is be passed over to compress the uterine fundus, suture will pass
      posteriorly and vertically to enter the posterior wall of the uterine cavity at the same
      level as the upper anterior entry point, it will be pulled under moderate tension assisted by
      manual compression exerted by the first assistant. The suture will be passed through
      posteriorly and vertically over the fundus to lie anteriorly and vertically compressing the
      fundus on the left side as occurred on the right. The needle is passed in the same fashion on
      the left side through the uterine cavity and out approximately 3 cm anteriorly and below the
      lower incision margin on the left side. The two lengths of the suture are will be tight,
      assisted by bi-manual compression to minimise trauma and to achieve or aid compression and
      the principal surgeon will throw a surgical knot.

      The two sutures were compare regarding need for hysterectomy, amount of blood loss will be
      assessed by number of soaked towels and suction titration, peripartum haemoglobin level drop
      (%) and haematocrit value change (%), number of received blood components (packed RBCs- fresh
      frozen plasma and platelets), procedure time (minutes), need for devascularisation, venous
      thromboembolism, postoperative pain and fever, hospital stay, number and cost of suture
      material used.
    

Intervention name(s): uterine compressive sutures
Intervention type(s): Procedure
Intervention description(s): uterine compression sutures comaprison
Other intervention name(s): b lynch and nusicaa sutures
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomised controlled trials 2 groups
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment