Clinical characteristics and outcomes of uterine compression sutures for postpartum hemorrhage during cesarean delivery.

OBJECTIVE

Uterine compression sutures (UCS) serve as a uterus-preserving option for the management of postpartum hemorrhage (PPH); however, the clinical characteristics associated with the need for additional treatment after UCS remain incompletely characterized. This study aimed to explore clinical factors associated with escalation to additional treatment after UCS.

METHODS

We conducted a single-center retrospective cohort analysis of 33 patients who underwent UCS for PPH during cesarean delivery between January 2011 and July 2025. Patients were categorized based on management with UCS alone or the requirement for additional interventions, including transcatheter arterial embolization (TAE) or emergency peripartum hysterectomy (EPH).

RESULTS

UCS alone achieved hemostasis in 23 patients (69.7%), whereas 10 patients (30.3%) required additional treatment (TAE, n = 3; EPH, n = 7). The incidence of suspected placenta accreta spectrum (PAS) was higher among patients requiring additional treatment than among those managed with UCS alone (60.0% vs. 8.7%; p = 0.004). Six of the eight patients with PAS (75.0%) required escalation, whereas all four patients with placental abruption achieved hemostasis with UCS alone; however, this finding should be interpreted cautiously because of the small number of cases. The estimated blood loss and intensive care unit admission rates were higher in the group requiring additional treatment. Ultimately, uterine preservation was achieved in 26 (78.8%) patients.

CONCLUSION

In this small retrospective cohort, UCS achieved hemostasis in many patients with PPH during cesarean delivery. Suspected PAS, particularly when complicated by placenta previa or a low-lying placenta, was associated with a higher need for additional treatment after UCS. However, because of the small sample size and limited number of events, these findings should be interpreted as hypothesis-generating rather than as definitive predictors of UCS failure.