A NEW ERA IN SURGICAL SUTURES- COMOC-MG STITCH: MODIFIED B LYNCH SUTURING TO CONTROL ATONIC POSTPARTUM HEMORRHAGE

Abstract

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, particularly in low-resource settings. Atonic PPH, characterized by the uterus's inability to contract effectively after delivery, accounts for approximately 70-80% of PPH cases. Traditional management techniques, such as the B-Lynch suture, while effective, present limitations including technical complexity and potential complications. The COMOC-MG stitch (Compression of Myometrium and Occlusion of Uterine Artery by Dr. Mahesh Gupta) is a novel modification aimed at enhancing the efficacy and safety of uterine compression sutures in controlling atonic PPH.

Aim: This study aimed to evaluate the effectiveness and safety of the COMOC-MG suture technique in managing atonic postpartum hemorrhage and in cases with anticipated high-risk factors.

Methods: A prospective cross-sectional study was conducted over six months, from July to December 2024, at the Department of Obstetrics and Gynaecology, Adichunchanagiri Medical College. A total of 30 women presenting with atonic PPH or high-risk factors for PPH (including multiple pregnancies, prolonged labor stages, fetal macrosomia, grand multiparity, and pre-eclampsia) were enrolled using consecutive sampling. Participants underwent the COMOC-MG stitch procedure, which integrates uterine artery ligation with myometrial compression. Data on demographic characteristics, procedural details, clinical outcomes, and postoperative complications were collected and analyzed using descriptive statistics.

Results: Results demonstrated a 100% success rate in achieving hemostasis without the need for additional surgical interventions. The average time to perform the COMOC-MG stitch was 4-5 minutes. Restoration of menses was observed in 25% of the cases, and only 25% required blood transfusions. Postoperative lower abdominal pain was reported in 15% of participants, with no instances of uterine infections, necrosis, or maternal mortality. Comparative analysis indicated that the COMOC-MG stitch outperformed the traditional B-Lynch technique in terms of success rates and reduction in additional interventions.

Conclusion: The COMOC-MG suture technique proved to be highly effective and safe in managing atonic PPH, achieving superior hemostasis rates and minimizing the need for further surgical procedures. The procedure's efficiency and favorable safety profile suggest its potential as a valuable intervention in obstetric care, especially in resource-limited settings. Further research with larger sample sizes and comparative studies is recommended to validate these findings and establish the COMOC-MG stitch as a standard practice in PPH management.