Compression uterine sutures Sutures

1. Cho square uterine sutures:

– Cho described a technique in which a straight needle with #1 chromic catgut is used to
place sutures in a small rectangular array to compress the anterior & posterior uterine walls
against one another at sites of heavy bleeding.
– The through & through sutures extend from the serosa of the anterior wall to the serosa of
the posterior wall.
– After creating a square, the ends are tied down as tight as possible to compress the
myometrium.
– 2-5 squares/rectangles are made, as needed

Cho square uterine sutures

2. Pereira uterine sutures :
– Pereira described a technique in which a series of transverse & longitudinal sutures of a
delayed absorbable multifilament suture are placed around the uterus via a series of bites into
the submucosal myometrium.
– 2-3 rows of these sutures are placed in each direction to completely envelope & compress
the uterus, similar to the way one might truss a stuffed roast.
– When the transverse sutures are brought through the broad ligament, care should be taken
to avoid damaging blood vessels, ureters, and fallopian tubes.
– The longitudinal sutures begin & end at the last transverse suture nearest the cervix, and do
not enter the uterine cavity.
– The myometrium should be manually compressed prior to tying down the sutures to
facilitate maximal compression
 Pereira stitch
3. Hayman uterine sutures :
– Hayman described a modification of the B-Lynch suture that is performed without a
hysterotomy.
– 2-4 vertical compression sutures are placed, as needed, but in contrast to the BLynch
technique, these sutures pass directly from the anterior uterine wall to the posterior uterine
wall.
– A transverse cervicoisthmic suture can also be placed if needed to control bleeding from the
lower uterine segment.
Hayman stitch

Hayman stitchs
4. B lynch uterine sutures :
– A large Mayo needle with #2 chromic catgut is used to enter & exit the uterine cavity at 1
& 2.
– The suture is looped over the fundus & then reenters the uterine cavity posteriorly at 3,
which is directly below 2. The suture should be pulled very tight at this point.
– It then enters the posterior wall of the uterine cavity at 4, is looped back over the fundus,
and anchored by entering the anterior lateral lower uterine segment at 5 & crossing through
the uterine cavity to exit at 6.
– The free ends at 1 & 6 are tied down securely to compress the uterus.
– The technique has been used alone & in combination with balloon tamponade. This
combination has been called the “uterine sandwich.”

B lynch suture
5. Bhal technique:
– The only modification to the B-Lynch suture.
-This entail 2 sutures instead of 1, with the knots tied in the anterior-inferior margin of the
lower uterine segment, without any difference in the compression effects compared to the
original B-Lynch suture.
Bhal technique