Cho Suture

Avoiding complications during placement of Cho compression sutures


We read with interest a paper by Dr. Reyftmann and col. They describe an unusual complication following Cho hemostatic suturein a case of postpartum hemorrhage. It would have been interesting if the authors had provided a picture or a description about the four Cho suture placements. This information is very important toknow, if there was a consequence of an inappropriate technique. Some reported complications of compression sutures can be avoided with simple measures: the dilatation of cervical oz can preventhematometra and also pyometra; the use of poliglactin 910 instead of catgut reduces a risk of synechiae and finally, the correct placement of compression sutures, alone or in combination with other hemostaticprocedures, can minimize the risk of necrosis. Recently, Gottlieb in the USA has described another case of necrosis, but in that case, the incorrect placement of two hemostatic procedures did notallow an accurate reperfusion of the myometrium throughout the collateral anastomotic network. The vascular blood supply of the uterus is superb, but it does not have the possibility to recover if theprocedure blocks the entire collateral network. This is the main cause of high risk of uterine necrosis, when the compression sutures were placed after uterine artery embolization. Regarding cases inwhich the myometrium was cut and there was subsequent intraabdominal hemorrhage, this also can be prevented if the nurses and doctors do not do perform a manual postpartum uterine compression.
Thismanoeuvre presses the compression suture, especially B-Lynch, and can cut the myometrium as a knife. Concerning this case, it is quite unusual to leave a significant amount of trophoblastic tissue afterCesarean. Maybe the pressure to adjust the Cho suture that included anterior, posterior myometrium and trophoblastic tissue was higher than standard. Consequently, the potential risk of necrosis was...