Triple vertical suturing in the management of uterine atony in a severe preeclampsia patient receiving magnesium sulfate treatment, a case report.

Postpartum hemorrhage remains the leading cause of maternal morbidity and mortality. Although various treatment options are available, some may pose a risk to future fertility. Nonsurgical interventions for the reduction and control of bleeding due to uterine atony are applied in a rapid sequence until hemostasis is achieved. All patients with uterine atony undergo uterine massage, manual compression, administration of uterotonic agents, and tranexamic acid. If these measures fail to control bleeding and the patient remains hemodynamically stable, uterine compression sutures can be applied. These sutures have been shown to effectively reduce uterine blood loss related to atony, and various techniques have been described in the literature. Among these, triple vertical uterine compression sutures represent a novel approach for managing uterine atony. In patients with severe preeclampsia, intrapartum and postpartum seizure prophylaxis with magnesium sulfate is routinely administered based on evidence from randomized trials demonstrating a significant reduction in the risk of eclampsia. While some reviews suggest that magnesium sulfate is not associated with an increased risk of atonic postpartum hemorrhage, data on this relationship remain inconclusive. In this case report, we describe a patient with severe preeclampsia who was receiving magnesium sulfate prophylaxis and developed uterine atony during a cesarean section. To manage the bleeding, we successfully applied triple vertical uterine compression sutures. Discussion: The use of three vertical uterine compression sutures does not require any additional specialized training. This makesit an optimal option. Its simplicity allows it to be easily performed by all obstetricians. Magnesium sulfate reduces the risk of eclampsia. There are reviews indicating that magnesium is not associated with atonic postpartum hemorrhage. Magneticsulfate should be administered intrapartum and postpartum for seizure prophylaxis.