A Commentary on: “A New Removable Uterine Compression by a Brace Suture in the Management of Severe Postpartum Hemorrhage”

Aboulfalah et al. (1) introduced a unique technique for a uterine compression suture (UCS), which included suture removal within 48 h after delivery. This technique is epoch-making. To obstetricians, the year 1997 is memorable regarding the treatment of postpartum hemorrhage (PPH), when B-Lynch et al. introduced the UCS (2), which dramatically changed the treatment of PPH from hysterectomy to uterus-conserving UCS. During the last two decades, up to 15 modified UCS techniques have been published; we introduced the Matsubara–Yano (MY) UCS (2). The hemostatic effectiveness of the UCS is well established (2). Uterine compression suture is not without side effects, including uterine necrosis, synechia, and infection (2). The UCS, by apposing the anterior and posterior uterine walls with a tied suture, necessarily limits blood flow to the uterus, which may cause uterine ischemia. The UCS remains in the uterine cavity until it is absorbed, which may lead to uterine infection. In either scenario, the suture is the culprit. Since the incidence rate of these adverse events is considered low, leaving the suture in place is considered a “necessary evil” for this life-saving procedure (2). The uterus usually contracts within a short period of time after delivery, resulting in hemostasis, and, thus, the “critical period” requiring the hemostatic effect of the UCS may be only 24–48 h after delivery. After this period, uterine compression may no longer be needed. Since the suture is responsible for adverse events and since uterine compression may be no longer needed after 48 h, removing the suture after 48 h may reduce the incidence of complications. Aboulfalah et al. (1) reported this approach, and that is why we consider their technique as epoch-making. Here, we offer clarification and concern. Clarification is needed regarding the technical procedure. The explanation offered by Aboulfalah may be a little obscure. Since they stated, “this technique deserves to be applied in greater number,” its clarificationmay be valuable for those unfamiliar with the technique.We interpret their technique as follows. A needle is used to penetrate the abdominal wall just above the symphysis pubis and then transfix the uterus (anterior→ posterior) in the lower uterine segment (Point A in Figures 1A,B). Then, the suture runs over the uterine fundus. This is Hayman’s simple brace suture (2). Then, importantly, the needle penetrates the abdominal wall (abdominal cavity→ surface) at a site 2 cm