==== Front Rev Bras Ginecol Obstet Rev Bras Ginecol Obstet 10.1055/s-00030576 RBGO Gynecology & Obstetrics 0100-7203 1806-9339 Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil 30991434 10.1055/s-0039-1683361 190014ler Letter to the Editor Authors’ Reply http://orcid.org/0000-0002-1807-5014 Moleiro Maria Lúcia 1 Guedes-Martins Luís 1 Mendes Alexandrina 1 Marques Cláudia 1 Braga Jorge 1 1 Woman’s and Reprodutive Medicine Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal Address for correspondence Maria Lúcia Moleiro, MD Departamento de Medicina Feminina e Reprodutiva, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do PortoLargo da Maternidade de Júlio Dinis4050-651 PortoPortugallucia.moleiro@gmail.com 3 2019 1 3 2019 41 3 207208 https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ==== Body pmc Comments on: Modified Pereira Suture as an Effective Option to Treat Postpartum Hemorrhage Due to Uterine Atony Dear Editor, The modification of the Pereira suture described by our team was performed during a cesarean section, when uterine atony was noted and was not responsive either to uterotonic drugs or to bimanual uterine massage. Given the success rates of uterine compression sutures (UCSs) described and the possibility of uterus preservation, they were the chosen method. Since hysterotomy had already been performed, the B-Lynch suture was the first technique used.1 As the uterine atony persisted, the Pereira technique was chosen due to its characteristics: an even distribution of pressure around the uterus, due to the small bites at regular intervals in the uterine wall; not entering the uterine cavity, thus reducing the risk (at least theoretically) of uterine synechiae and infection; the ability to prevent the sliding out of the thread after uterus involution, reducing the risk of bowel and intestine entrapment.2 The emergent need for hemorrhage control in cases of uterine atony limits the existence of quality evidence stating superiority amongst UCS techniques. Nevertheless, previous reviews report success rates > 75% (some of them > 90%), regardless of technique.3 4 5 6 In these works, variations of the B-Lynch suture were reported as being as effective or even superior to the original technique. However, the chosen technique may not be the only variable contributing to the disparity of results, and the timing in which uterine compression sutures are applied, as well as surgeons’ experience, is of vital importance.3 6 7 8 9 10 11 12 The two cases reported by our team do not intend to describe a new technique, but rather to support UCSs as an adequate option to treat postpartum hemorrhage due to uterine atony, always bearing in mind the characteristics of each situation and the specificities of each suture. Conflicts of Interest The authors have no conflicts of interest to declare. ==== Refs References 1 B-Lynch C Coker A Lawal A H Abu J Cowen M J The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported Br J Obstet Gynaecol 1997 104 03 372 375. Doi: 10.1111/j.1471-0528.1997.tb11471.x9091019 2 Pereira A Nunes F Pedroso S Saraiva J Retto H Meirinho M Compressive uterine sutures to treat postpartum bleeding secondary to uterine atony Obstet Gynecol 2005 106 03 569 572. Doi: 10.1097/01.AOG.0000168434.28222.d316135589 3 Sathe N A Likis F E Young J L Morgans A Carlson-Bremer D Andrews J Procedures and uterine-sparing surgeries for managing postpartum hemorrhage: a systematic review Obstet Gynecol Surv 2016 71 02 99 113. Doi: 10.1097/OGX.000000000000027326894802 4 El Refaeey A EA Abdelfattah H Mosbah A Is early intervention using Mansoura-VV uterine compression sutures an effective procedure in the management of primary atonic postpartum hemorrhage?: a prospective study BMC Pregnancy Childbirth 2017 17 01 160. Doi: 10.1186/s12884-017-1349-x28569213 5 Mohamed M A Mohammed A H Parallel vertical compression sutures to control bleeding in cases of placenta previa and accreta J Matern Fetal Neonatal Med 2019 32 04 641 645. Doi: 10.1080/14767058.2017.138789529034750 6 Şahin H Soylu Karapınar O Şahin E A Dolapçıoğlu K Baloğlu A The effectiveness of the double B-lynch suture as a modification in the treatment of intractable postpartum haemorrhage J Obstet Gynaecol 2018 38 06 796 799. Doi: 10.1080/01443615.2017.142004629557226 7 Mallappa Saroja C S Nankani A El-Hamamy E Uterine compression sutures, an update: review of efficacy, safety and complications of B-Lynch suture and other uterine compression techniques for postpartum haemorrhage Arch Gynecol Obstet 2010 281 04 581 588. Doi: 10.1007/s00404-009-1249-z19834719 8 Kayem G Kurinczuk J J Alfirevic Z Spark P Brocklehurst P Knight M ; U.K. Obstetric Surveillance System (UKOSS). Uterine compression sutures for the management of severe postpartum hemorrhage Obstet Gynecol 2011 117 01 14 20. Doi: 10.1097/AOG.0b013e318202c59621213474 9 Palacios-Jaraquemada J M Efficacy of surgical techniques to control obstetric hemorrhage: analysis of 539 cases Acta Obstet Gynecol Scand 2011 90 09 1036 1042. Doi: 10.1111/j.1600-0412.2011.01176.x21564024 10 Doumouchtsis S K Papageorghiou A T Arulkumaran S Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails Obstet Gynecol Surv 2007 62 08 540 547. Doi: 10.1097/01.ogx.0000271137.81361.9317634155 11 Gizzo S Saccardi C Patrelli T S Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature Fertil Steril 2013 99 07 2097 2107. Doi: 10.1016/j.fertnstert.2013.02.01323498891 12 Cekmez Y Ozkaya E Öcal F D Küçüközkan T Experience with different techniques for the management of postpartum hemorrhage due to uterine atony: compression sutures, artery ligation and Bakri balloon Ir J Med Sci 2015 184 02 399 402. Doi: 10.1007/s11845-014-1130-324831795