Postpartum hemorrhage (PPH) is a life-threatening complication of delivery. It is the leading cause of maternal death (1), with 1 to 13% of births around the world affected (2). In Morocco PPH was around 132/100,000 in 2009 were documented with PPH complication. It occurs in approximately 4% of vaginal deliveries and 6% of cesarean deliveries (3). Definition of PPH differs between authors; in general, it is a loss of more than 500 ml of blood after vaginal delivery or 1000 ml after cesarean section (2). Severity criteria are uncontrolled bleeding after initial medical management of PPH, hemodynamic instability even resuscitation by crystalloids and red blood cells, and presence of coagulation disturbances. Surgery is then indicated. Since the first publication of B-lynch technique in 1997 (4), different uterine compression sutures have been described and performed as an alternative to hysterectomy. Based on compressive sutures, they have proven to be valuable and safe in the control of massive PPH (5). Recently, uterine synechia has been reported as a frequent complication of those sutures, with 18–54% frequency, which surely compromises fertility (6, 7). Sutures that run through the full thickness of both anterior and posterior uterine walls and infection are involved in this complication.

In order to prevent synechia and using two uterine bleeding control mechanisms, we conceptualized and performed from 2006 to 2011 a new uterine compressive brace suture procedure (initially described by the first author), in 15 patients with severe PPH, in the gynecology obstetrics department of Mohammed VI university hospital, Marrakech, Morocco.

In our 15 procedures, as described in Table 1, PPH occurred in 11 cases (73%) after vaginal delivery and in 4 cases (27%) after cesarean section. Eighty percent were caused by uterine atony. In 11 cases, the technique was realized secondarily after vascular ligature failure alone, and in 1 case after partial uterine resection for accret placental. One hundred percent of hemostasis was obtained; one (7%) secondary hysterectomy was done for bleeding relapse 3 h later. One death occurred secondary to preeclampsia with cerebral vascular accident. No particular complications were noted. During post-operative follow up, all patients regained their normal menstrual cycles. Five pregnancies were attempted, and three normal pregnancies were achieved.

We describe an innovative method, which is simple, effective, easy to learn, tried with successful outcome for the control of severe PPH as an alternative to more complicated surgeries like hysterectomy. This technique uses two mechanisms of bleeding control by compression of placental site by tight compression of uterine walls and by obstruction of blood flow through uterine arteries by extreme forward flection of the uterus.

Preventing uterine synechia is possible because uterine cavity is respected, there is no need to open the cavity by a new hysterotomy compared to original B-Lynch suture (4–8), and suture does not pass through the full thickness of both anterior and posterior uterus body wall compared to cho sutures (9), or to compressing U-sutures (10). Also it is known that inflammation around sutures and infection are responsible of synechia. So, the most innovative particularity of our technique is the removal of the suture 24 or 48 h later. This is the first time that a compressing uterine suture technique is followed by removal of the suture, and these three details may be the key of preventing synechia by decreasing the risk of infection. There is no foreign body inside the uterine cavity, and spontaneous cervical drainage is done after suture removal; hence, pyometra is avoided. Also, removing sutures prevents joining of endometrial walls over time, which itself increases the risk of infection.

Removable uterine brace compressive against pubis suture is a promising technique, simple, safe, and effective in management of severe PPH, adapted to most of PPH causes, from uterine atony to placenta accreta. It may prevent synechia and help maintain fertility by respecting uterine cavity and this more precisely by percutaneous removing of the suture 24–48 h later. We think that this technique deserves to be applied in greater number with added systematic hysteroscopy control to prove its superiority in synechia prevention.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.