The COMOC-MG surgical Technique for the management of Postpartum Haemorrhage: Experience from East Africa

Abstract

Background: Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, accounting for approximately 30–50% of maternal deaths, with sub-Saharan Africa carrying a disproportionate burden. The risk is further heightened in caesarean deliveries, where PPH contributes to nearly one-third of maternal deaths in low- and middle-income countries. Despite the availability of effective preventive and management strategies, persistent gaps in implementation driven by resource constraints, delayed diagnosis, and limited surgical capacity continue to undermine outcomes. The COMOC-MG technique, a modified uterine compression suture that integrates myometrial compression with bilateral uterine artery occlusion, offers a promising, efficient, and uterus-preserving intervention, with reported success rates of up to 98%. Methods: A retrospective case series was conducted at Jacaranda Maternity Hospital, Nairobi, Kenya, involving seven consecutive high-risk patients who developed atonic PPH during caesarean delivery. All patients had failed initial management with uterotonics and tranexamic acid before undergoing the COMOC-MG technique. Data were obtained from operative records, including clinical characteristics, intraoperative findings, estimated blood loss, transfusion requirements, and outcomes. Results: Seven patients aged 25–37 years underwent the COMOC-MG technique at gestational ages of 37–41 weeks. Uterine atony was confirmed intraoperatively in six of seven cases; the remaining case involved gross atony complicated by a uterine myoma requiring concurrent myomectomy. Estimated blood loss ranged from approximately 700 mL to 2000 mL. Blood transfusion requirements varied from none (two patients) to six units of whole blood (one patient with confirmed PAS). The COMOC-MG technique achieved hemostasis in six of seven patients (85.7%), preserving the uterus in all but one case. One patient with confirmed placenta accreta spectrum and disseminated intravascular coagulation (DIC) required peripartum hysterectomy despite all conservative measures. All patients were discharged with favorable maternal outcomes; all seven neonates were born alive, with one requiring neonatal intensive care unit admission. Conclusion: This small case series suggests that the COMOC-MG technique can effectively achieve hemostasis and preserve the uterus in most high-risk atonic PPH cases during caesarean delivery in resource-limited settings. The observed uterine preservation rate of 85.7% aligns with existing literature. However, the findings should be interpreted cautiously due to the small sample size, single-center design, and lack of a comparison group. The technique appears to be a low-cost and feasible option where resources are limited. Larger prospective studies are needed to confirm its efficacy, safety, and broader applicability. Keywords: modified B-Lynch suture, COMOC-MG, Postpartum hemorrhage, Maternal mortality, Uterine atony