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 and posterior uterine walls against one another at sites of heavy bleeding.
– The through and 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
2. Pereira uterine sutures :
– Pereira described a technique in which a series of transverse and 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 and 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 and 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
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 B Lynch 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.
4. B lynch uterine sutures :
– A large Mayo needle with 2 chromic catgut is used to enter and exit the uterine cavity at 1 and 2.
– The suture is looped over the fundus and 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 and crossing through the uterine cavity to exit at 6.
– The free ends at 1 and 6 are tied down securely to compress the uterus.
– The technique has been used alone and in combination with balloon tamponade. This combination has been called the “uterine sandwich.”
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.
