Bateman et al reported an increased rate of hysterectomy for severe postpartum hemorrhage in the United States from 1994-2007. This study is pessimistic and does not reflect the high efficiency of new surgical procedures to stop severe postpartum hemorrhage. Indeed, the first publication on the very high success rate of multiple square sutures to control severe postpartum hemorrhage was in 2000; therefore, it is normal that the application of this technique in routine practice and its positive consequences appear many years later. This explains the reason that there is no drop in peripartum hysterectomy rates. Indeed, multiple square sutures are very efficient to control severe postpartum hemorrhage when they are applied correctly. The rate of success is >90% on uterine atony. Moreover, fertility is preserved after multiple square sutures, and subsequent pregnancies are possible.

Since 2004, after the introduction of multiple square sutures in our department to control severe hemorrhage, we have observed a drop in hysterectomy rates after uterine atony during cesarean section delivery. Severe postpartum hemorrhage remains difficult to control in cases of placenta accreta or percreta, but rarely in the case of uterine atony, which is the most frequent situation.

Because severe postpartum hemorrhage that is not controlled by medical treatment is rare, even in big maternity centers, obstetricians should be trained to perform multiple square sutures in emergency situations and on inanimate surgical models to avoid hysterectomy.