Clinical Factors Associated With Failure of Uterine Compression Sutures in Postpartum Hemorrhage During Cesarean Delivery: A Systematic Review

Uterine compression sutures can preserve the uterus during refractory postpartum hemorrhage, but clinical factors associated with failure are less well established than overall success rates.This review examined evidence specifically applicable to cesarean delivery.PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Scopus, and Web of Science were searched without a lower publicationdate restriction.Eligible studies were peer-reviewed primary investigations of therapeutic uterine compression sutures with cesarean-specific clinical-factor information linked to treatment outcomes.Additional hemostatic treatment and hysterectomy were considered separate endpoints.Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool, and findings were synthesized narratively, supplemented by study-level effect estimates and an exploratory pooled analysis of event proportions.Of 1,010 identified records, 374 remained after deduplication; of these, 76 reports underwent full-text assessment, and finally four studies were included.Their original cohorts contained 105 women, of whom 102 underwent cesarean delivery.Two studies were rated at low overall risk of bias and two at high risk.Placental pathology was the principal directly evaluable clinical factor, although placenta previa and suspected placenta accreta spectrum represented distinct exposures; escalation was more frequent with suspected placenta accreta spectrum.Evidence for other factors was sparse, and factor-specific estimates were not pooled.In an exploratory random-effects analysis, immediate hemorrhage-related hysterectomy occurred in 21.7% (95% CI 14.7-30.8%) of treated cesarean cases.The evidence supports attention to hemorrhage etiology and a distinction between escalation of treatment and loss of the uterus.It does not establish a validated cesarean-specific prediction model or a reliable threshold for abandoning compression sutures.