• Wai Yoong, Alexandra Ridout, Maria Memtsa, Andreas Stavroulis, Mernoosh Aref-Adib, Zeudi Ramsay-Marcelle, and Abiodun Fakokunde.
• Department of Obstetrics and Gynecology, North Middlesex University Hospital, London, UK. wai.yoong@nmh.nhs.uk
• Acta Obstet Gynecol Scand. 2012 Jan 1; 91 (1): 147-51.

AbstractWe evaluated in a prospective observational study the use of a 'uterine sandwich' technique (uterine compression sutures in association with intrauterine tamponade) in women who had had unsuccessful medical treatment for postpartum hemorrhage. Ten of the 11 patients had cesarean sections (complicated by placenta previa and uterine atony) and one had a normal delivery. The median estimated blood loss and units of blood transfused were 1500ml (range 750-4000ml) and two units (range 0-9), respectively. B-Lynch sutures were placed in two patients and Hayman's modification was used in nine. Bakri balloon tamponade was in place for a median of 22 hours (range 17-27 hours), while the median volume infused in the balloon was 300ml (range 150-350ml). The combined technique was successful in avoiding hysterectomy in all cases, and there was no documented postpartum morbidity. This is a simple and quick surgical technique that can be used to treat atonic postpartum hemorrhage, particularly in conjunction with placenta previa.© 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

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