We appreciate the interest of Drs Alouini and Mesnard in our study. We share the authors’ enthusiasm for uterine compression sutures as a treatment of severe postpartum hemorrhage and agree that in many circumstances their use may prevent the need for peripartum hysterectomy.

While our study showed a substantial rise in the rate of peripartum hysterectomy in the United States from 1994 through 2007, particularly for uterine atony, we do not interpret this to suggest a lack of efficacy for these techniques. Rather, as the authors suggest, it likely reflects the lack of integration of these approaches into routine clinical practice.

Our paper should not be read as a pessimistic commentary on efficacy of this approach, but rather as a call to action to disseminate these techniques and encourage their use in appropriate patients.