Comments on: Modified Pereira Suture as an Effective Option to Treat Postpartum Hemorrhage
Due to Uterine Atony
Dear Editor,
The modification of the Pereira suture described by our team was performed during
a cesarean section, when uterine atony was noted and was not responsive either to
uterotonic drugs or to bimanual uterine massage. Given the success rates of uterine
compression sutures (UCSs) described and the possibility of uterus preservation, they
were the chosen method.
Since hysterotomy had already been performed, the B-Lynch suture was the first technique
used.[1] As the uterine atony persisted, the Pereira technique was chosen due to its characteristics:
an even distribution of pressure around the uterus, due to the small bites at regular
intervals in the uterine wall; not entering the uterine cavity, thus reducing the
risk (at least theoretically) of uterine synechiae and infection; the ability to prevent
the sliding out of the thread after uterus involution, reducing the risk of bowel
and intestine entrapment.[2]
The emergent need for hemorrhage control in cases of uterine atony limits the existence
of quality evidence stating superiority amongst UCS techniques. Nevertheless, previous
reviews report success rates > 75% (some of them > 90%), regardless of technique.[3]
[4]
[5]
[6] In these works, variations of the B-Lynch suture were reported as being as effective
or even superior to the original technique. However, the chosen technique may not
be the only variable contributing to the disparity of results, and the timing in which
uterine compression sutures are applied, as well as surgeons’ experience, is of vital
importance.[3]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
The two cases reported by our team do not intend to describe a new technique, but
rather to support UCSs as an adequate option to treat postpartum hemorrhage due to
uterine atony, always bearing in mind the characteristics of each situation and the
specificities of each suture.
