Compression suture for the control of obstetric hemorrhage due to atony and preservation of the uterus with the Tovar-Montiel technique. Pilot study.

Background: Surgical management of obstetric hemorrhage due to atony with preservation of the uterus continues to be a major unresolved challenge.

Objectives: To describe the Tovar-Montiel technique and to analyze the results of its performance in a case series with uterine atony.

Material and method: Interventional, cross-sectional, descriptive and analytical study in a case series of 30 patients with uterine atony without response to pharmacological management treated in a High Specialty Medical Unit in Mexico City from March 2018 to May 2019. Performed a compressive uterine suture with the Tovar-Montiel technique. Termination of pregnancy, Tovar-Montiel suture time, total surgical time, estimated bleeding, transfusion requirement, other interventions, and outcome were studied. For data analysis, descriptive and inferential statistical measures were used with the SPSS version 25 program.

Results: Age 30±7.3 years, parity 3, primiparity 27% and morbidity 60%. The Tovar-Montiel suture was performed in 90% after cesarean section and in 10% after vaginal delivery through an abdominal incision. Tovar-Montiel suture time 2 to 3 minutes, total surgery time 58±20 minutes, estimated bleeding 950±500 ml, transfusion 57%, hypogastric artery ligation 27%, hysterectomy 3.33%, mid-postoperative pelvic abscess 3.33%, hospital stay 5 days and mortality 0%.

Conclusions: With the Tovar-Montiel uterine compression suture, the uterus was preserved in 97% of the cases. The technique may be an option for management of atony and preservation of the uterus.

Keywords: Obstetric hemorrhage; Uterine atony; Uterus preservation; Uterine compression suture; Tovar-Montiel technique.

Keywords: Obstetric hemorrhage.