Longitudinal parallel compression suture is a safe, easy, effective, practical, and conservative surgical technique to stop intractable PPH from the lower uterine segment, particularly in women who have a cesarean scar and placenta previa/accreta.

The procedure can be used as an alternative to peripartum hysterectomy and also as a prophylactic application in PPH.

Uterine folding hemostasis is a simple, safe and effective technique to control the atonic PPH.

Since the introduction of the B-Lynch uterine compression suture (UCS) in 1997, 1 various UCS have been devised to control post-partum hemorrhage (PPH) caused by uterine atony, placenta previa or abnormally adherent placenta.2,3 As other authors have noted, each of these sutures has both merits and drawbacks; high-level evidence has not been demonstrated as to whether the compression sutures achieve better and safer hemostasis for PPH than other methods, and, if they do, whether one suture is more efficient and safer than another.2 Thus, when choosing a UCS, besides its efficacy and safety, we also consider which suture is simpler and more cost-effective.We devised a novel UCS, Li's suture (the 'one thread, three punctures' method) and present it in Figures 1 and 2. The suture was performed for PPH caused by uterine atony in 12 women in whom blood loss failed to stop after initial routine management (i.e, bimanual uterine massage, gauze packing, and appropriate uterotonic agents, etc.), and the suture was sufficient to arrest bleeding immediately in 10 patients (83.3%, 10/12). Two women with placental abruption underwent hypogastric arteries ligation after the procedure for continuous bleeding coming from the uterus. We found no morbidities or abnormalities of the uterus or pelvic cavity related to this suture. Subsequent pregnancies occurred at 22-36 months after this suture in two women who delivered with repeat cesarean section. The other patients did not desire future fertility. The study protocol was approved by the ethics committee of Meitan General Hospital.Similar to other UCS techniques, 2-4 this suture enables us to avoid emergency hysterectomy in all patients and thus preserves their fertility and obviates any other surgical complications of hysterectomy in these critical circumstances. Its advantages include: (i) the procedure is simple and easy to learn, and only requires three punctures; (ii) it only uses one thread, which is relatively more cost-effective; and (iii) the procedure does not require the opening or re-opening of the incision in the lowersegment uterine wall, which reduces the time of the surgical suture, provides an opportunity to lessen blood loss, and decreases the therapeutical charges. Therefore, it is apparent that the procedure is successful in most patients and should be incorporated or even be the first-line surgical management for PPH due to uterine inertia. However, we do not claim the overall superiority of Li's suture over any other compression suture, because our research is the limited to a small number of patients and still requires a long-term comparison with other UCS to determine its effectiveness and safety. The arrows indicate the direction and line of the suture; the numbers represent the puncture point and the pierce sequence.