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Taiwanese Journal of Obstetrics & Gynecology 50 (2011) 179e181

Short Communication

Hayman uterine compression stitch for arresting atonic postpartum
hemorrhage: 5 years experience
Smiti Nanda, Savita Rani Singhal*
Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Accepted 1 December 2009


Objectives: The present study was planned to access the efficacy of Hayman uterine compression stitch which is easy, can be applied faster and
avoids the performance of a lower segment hysterotomy in patients with atonic postpartum hemorrhage.
Materials and Methods: It is a study carried out from January 2004 to December 2008 at a tertiary care center and included 48 women who had
intractable atonic PPH not managed with medical treatment and who were wishing to preserve their fertility. Hayman stitch which is a simplified
approach to uterine compression sutures was performed by tying two parallel vertical sutures from just above the bladder reflection to the fundus
of the uterus.
Results: With Hayman stitch hysterectomy was avoided in 93.75% (45 out of the 48) patients with PPH. The postoperative course was
uncomplicated, six women conceived spontaneously within 12 month after uterine compression suturing. Four delivered vaginally and two
underwent cesarean section in view of fetal distress. The uterine cavity was found to be normal during caesarean section.
Conclusion: Two parallel vertical compression sutures (Hayman stitch) placed in the uterus controls bleeding effectively. The technique is easy,
rapid and requires less skill and this simple procedure be tried first before other complex measures like uterine artery ligation are undertaken
particularly for those obstetricians who lack sufficient training and skill.
Copyright Ó 2011, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. All rights reserved.

Keywords: Hayman stitch; Postpartum hemorrhage

Introduction In recent decades, active attempts have been made to
introduce conservative procedures to avoid hysterectomy.
Postpartum hemorrhage (PPH) is a major cause of maternal Within the past years, interest has surged in the surgical
mortality worldwide ranging from 13% in developed countries compression sutures for treating atonic PPH by exerting
to 34% in developing countries [1]. Uterine atony is the a mechanical compression on uterine vascular sinus without
commonest cause for PPH that accounts for 80% of the cases. occluding the uterine arteries. Of the several different tech-
Although an assessment of risk factors is important, PPH niques, the B-lynch suture, first reported in 1997, has gained
typically occurs unpredictably and no parturient is exempt the most popularity [2].
from the risk. When PPH continues despite aggressive medical Hayman stitch is a simplified approach to uterine compres-
treatment, early consideration should be given to surgical sion sutures that involved slight modifications of the B-lynch
intervention to prevent the morbidity. technique [3]. This suture offers the advantages of being easier,
can be applied faster, a key point in emergency situation, and
avoids the need to perform a lower segment hysterotomy when
PPH follows a vaginal delivery, therefore minimizing the
* Corresponding author. Department of Obstetrics and Gynecology, Post
Graduate Institute of Medical Sciences, 14/8FM, Medical Campus, Rohtak
trauma to the atonic bleeding uterus. We report our experience
124001, Haryana, India. in the use of the Hayman stitch for the conservative surgical
E-mail address: (S.R. Singhal). management of massive PPH.

1028-4559/$ - see front matter Copyright Ó 2011, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. All rights reserved.

A number two chromic catgut suture on a straight no delay in resumption of normal menstruation following the needle was used to transfix the uterus from front to back.56  3. delivery. uterine necrosis.180 S. Hypogastric artery ligation is the most effective way to control hemorrhage while still preserving the uterus [5]. stitch. the lower transverse uterine incision was closed first. primary (20 IU in 500 mL saline at rate of 125 mL/hr). In others who were medical management of PPH was done as described in hemodynamically stable and willing to preserve the fertility. vascular perforation. there were a total of PPH were included in the study. All the women who were subjected to the Hayman stitch for atonic During the study period of 5 years. The study was carried out from January 2004 to December 2008 in the Department of Obstetrics & Gynecology at Results a tertiary care referral center. and 800 mg of of failure of either ligation procedure (10 women. and secondary hysterectomy (13) because prostaglandin F2a (250 mcg intramuscularly). 1. Selective arterial embolization is another option of conserving uterus while managing PPH.50% were primipara. One of the reasons for this could be the delay in resorting to surgical techniques once conservative measures have failed [4]. Nanda. If these measures underwent surgical intervention needed at least two units of failed to control the hemorrhage. Thirteen women Facility for arterial embolization did not exist at the hospital. 6. while an assistant applied bimanual four delivered vaginally and two underwent caesarean section compression. the following enough to have a need of blood transfusion. the surgeon ensured that the vaginal bleeding was normal. S. if the woman is hemodynamically stable. Hayman uterine compression stitch. One more vertical suture was applied parallel to in view of fetal distress. and infection [7]. bimanual from the hospital in good conditions. Thus. There was the bleeding. availability of a skilled interventional radi- ologist and radiology setup in proximity is a prerequisite. Hayman uterine compression stitch. this surgical technique is difficult and requires a high degree of surgical skill and training and may be associated with ureteric injury [6]. 1).15%) had atonic PPH severe hospital was that once atonic PPH was identified. Only the 48 women who underwent hysterectomy for hemodynamic instability. internal or uterine artery ligation (27). (27.92%) had The patient was directly taken for hysterectomy. Six women conceived spontane- above the reflection of the bladder. In cases of PPH occurring after caesarean normal during caesarean section. and was then tied above the ously within 12 month after uterine compression suturing and fundus of the uterus. three women uterine artery ligation or the Hayman stitch depending on the continued to bleed after compression stitch and required surgeon’s experience. hemodynamically unstable or in shock. mean age was ligation.129 deliveries and 427 (1. with Hayman Hayman stitch during this period were included in the study. The protocol followed at the 37. Fig. there may not be an experienced surgeon on site to perform the ligation. Before closing the abdomen. injection of hysterectomy (31). such 106 underwent surgical intervention in the form of Hayman as intravenous fluids. The procedure has its own complications of postprocedure fever. However. The uterine cavity was found to be the first one (Fig.75 % (45 of 48) The procedure for Hayman stitch was that the abdomen was women with PPH.04%) or misoprostol in rectum after ruling out the contraindications Hayman stitch (3 women. measures were used initially to manage the bleeding. Of these 48 cases. surgical intervention was the blood transfusion. Data about the surgical procedure and follow-up visits were analyzed.1 years and 37. . or hysterectomy. 37. Of 427 women. In all the women.08%) had PPH after vaginal delivery and 35 (72. Singhal / Taiwanese Journal of Obstetrics & Gynecology 50 (2011) 179e181 Methods then annually. if not so as in cases following vaginal delivery and the cated and the women had normal lochia and were discharged uterus was exteriorized. initiated in the form of internal iliac artery or uterine artery On analyzing the data of 48 women. The postoperative course was Discussion monitored and women were followed 2 weeks after discharge from the hospital thereafter every 2 month for the first year and PPH can cause exsanguinations rapid enough to be fatal despite immediate availability of blood products. if she was PPH after lower segment cesarean section.R. The traditional surgical techniques to achieve hemostasis include internal iliac artery ligation or caesarean hysterectomy. In an emergency. All the women who along with arranging for blood transfusion. infusion of oxytocin stitch (48). uterine massage.25%). Only 21 women came for uterine compression was done to check whether this stopped follow-up in first year and 9 women in second year. methods except in one woman where prostaglandin F2a was conservative surgery was done in the form of internal iliac or not given as she had asthma. Before applying the suture. hysterectomy could be avoided in 93. The postoperative course was uncompli- opened. just cessation of breastfeeding. Round the clock. It is a retrospective study. 22.

Say L. formed as a first step before considering the diagnosis of 99:502e6. Br J Obstet Gynecol 2005. Br J Obstet Gynecol 2005. collection of blood clots within the [4] Reich WJ. Arulkumaran S. Gulmezoglu AM. Rojat-Habib MC. Girling J. S. Nanda. Bruce SR. Nechtow JR. Br J Obstet Gynecol 1997. Br J Obstet Gynecol 2005. complex procedures. measures fail to do so. . and during caesarean section. theoretical concerns on the potential risks of the 104:372e5. Ligation of internal iliac arteries: a lifesaving procedure for uncontrollable gynaecologic and obstetric haemorrhage. Hayman stitch suture technique. Obstet Gynecol 2002. first. Cowen M. Wojdyla D. have been used. Chen CP. in the face of B-Lynch [8] was the first to propose the innovative principle uncontrolled hemorrhage. The B-Lynch surgical to appose the anterior and posterior wall above the bladder technique for the control of massive postpartum haemorrhage: an alter- native to hysterectomy? Five cases reported. S. Obstet Gynecol 2002. Singhal / Taiwanese Journal of Obstetrics & Gynecology 50 (2011) 179e181 181 Thus.9]. Su TH. References including Hayman stitch. both the uterine walls is an effective measure to control bleeding in PPH because of uterine atony. Abu J. Since the original report. Allaire AD. uterine segment effectively controls bleeding when medical 25:150e2.112:122e3. Paul RH. WHO have the added advantage of being simpler to perform and analysis of causes of maternal death: a systemic review. uterine atony. dead space in the uterine cavity from which blood or fluid Uterus and bladder necrosis after uterine artery embolization for post- cannot escape. It may be [6] Clark SL. various modifications of the B-Lynch procedure. Roger V. Uterine compression suture without hysterotomy- parallel vertical compression sutures placed in the lower why a non-absorbanle suture should be avoided. Obstet Gynecol 1985. Jacquier A. Coker A. uterine cavity exploration should be per. the patient later developed Asherman’s syndrome. second. Mazouni C. Partial ischemic necrosis of the uterus following a uterine technique avoids such a dead space. Lawal A. Hypogastric artery ligation for obstetric haemorrhage. reflection. Lancet 2006. Pyometra after haemostatic square either immediate or long-term complications. may be a valuable addition to the current armamentarium of safe. avoiding the need to open the uterus. Because Hayman stitch involves crossing the uterine cavity [2] Lynch CB. 367:1066e74. Ochoa et al [10] reported a case of sutures: a technique to control bleeding from placenta praevia or accreta pyometra after using the multiple square suture technique. cost-effective uterine preserving procedure. Steer PJ. which can be conservative treatment of atonic PPH particularly for those adopted in emergency situations even by obstetricians who gynecologists who lack sufficient training and skill for more lack sufficient training and skill for more complex procedures. Uterine compression sutures: combat this. Parallel vertical compression suturing is undertaken. we require a simple.66:353e6. The modifications [1] Khan KS.99:506e9. this simple procedure be tried first that a compression suture running through the full thickness of before other complex measures are undertaken. because of the fact that their technique constructs a square [7] Porcu G. Chen HS.36:157.R. It is concluded that. The technique appears to minimize [10] Ochoa M. Girard G.112:1420e3.112:126e7. cavity occlusion and infections have been raised [8. It is concluded that two brace compression suture. Yeh SY. Van Look PF. J Obstet Gynecol 2005. Stitely ML. for managing massive PPH. To [3] Hayman RG. [9] Cotzias C. compression to both sides of the uterus at the time when the [5] Hwu YM. Neither hematometra nor pyometra was the partum haemorrhage. uterine cavity can be averted by applying bimanual J Int Coll Surg 1961. surgical management of post partum hemorrhage. complication in present study as the parallel vertical suture [8] B-Lynch C. Phelam JP.