History of Surgical Remedies for Obstetrical Uterine Hemorrhage

  • Satoru TakedaEmail author
  • Yasuhisa Terao


Arterial ligation and stepwise uterine devascularization were formerly used as hemostatic techniques to control massive hemorrhage during cesarean section without hysterectomy and to preserve the uterus. However, depending on the sites of arterial ligation, the hemostatic effect was often inadequate because of collateral circulation. Subsequently, insufficient blood flow and ischemia in the preserved uterus caused ovarian dysfunction and endometrial growth impairment, (e.g., hypomenorrhea, oligomenorrhea, amenorrhea, and infertility). Furthermore, it has been recognized that subsequent pregnancies can be complicated by premature labor, spontaneous abortion, placenta accreta, etc. At present, arterial ligation is not performed.

In place of this technique, various compression sutures, including the B-Lynch suture which was first reported in 1997, are the current mainstream hemostatic techniques for uterine hemorrhage during cesarean section and are widely used in clinical practice. Moreover, Bakri et al. reported favorable hemostatic outcomes when managing hemorrhage from placenta previa and placenta previa accreta by balloon tamponade. This technique is used for hemostasis in uterine hemorrhage not only during cesarean section but also after vaginal delivery. The hemostatic techniques in use have recently undergone diversification, including application of a combination of intrauterine compression hemostasis and balloon tamponade and intraoperative arterial embolization, performed in a hybrid operating room.


Critical uterine hemorrhage Cesarean section Compression sutures Uterine balloon tamponade Interventional radiology Arterial embolization Arterial balloon occlusion Damage control 


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Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Faculty of MedicineJuntendo UniversityBunkyo-kuJapan

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