Journal of Obstetrics and Gynaecology, May 2009; 29(4): 364–365
LETTERS TO THE EDITOR
Re: Bhattacharya R, Gobrial H, Barrington JW, Isaacs J. 2008. Psoas
abscess after uncomplicated vaginal delivery: an unusual case. Journal
of Obstetrics and Gynaecology 28:544–546
Dear editor,
I appreciated the case report by Bhattacharya et al. (2008) on psoas
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abscess after uncomplicated vaginal delivery, published in the
Journal of Obstetrics and Gynaecology. However, I would like to
bring to the attention of the authors the reference discussed in their
case report by Garagiola et al. (1989).
In the case report, it says ‘Asymptomatic muscle haematoma has
been described after normal delivery and it can become infected’. I
think it is irrelevant to their particular case report about psoas
abscess after normal vaginal delivery. The reference quoted by
Garagiola et al. (1989) is of a case of haematoma adjacent to the
left obturator internus muscle, measuring 2 6 3 6 4 cm, in a
patient who received pudendal anaesthesia. In the discussion, they
have clearly attributed this finding to pudendal anaesthesia,
acknowledging it as a well recognised complication of the
For personal use only.
pudendal anaesthesia. Hence, in the case report by (Bhattacharya
et al. 2008) on psoas abscess, the possible cause of abscess and the
muscle involved is quite different to the reference made.
Correspondence: J. Rafi, Maternity and Child Health Department, Basingstoke and North Hampshire NHS Trust, Basingstoke RG24 9NA,
UK. E-mail: drjunaidrafi@hotmail.com
DOI: 10.1080/01443610902878791
Re: MacLean AB, MacLean SB. 2008. Suture materials and subsequent
wound strength. Journal of Obstetrics and Gynaecology 28:561–562
Dear Sir,
I read with interest the editorial about suture material for closing
the uterine wound during caesarean section (Maclean and
Maclean 2008) following the publication in the Journal of
Obstetrics and Gynaecology of two case reports about sponta-
neous rupture of the scar during the second trimester, where the
placenta was not implanted over the scar area. The editorial
suggests that closing the uterine wound using chromic catgut,
which was used decades ago, might lead to stronger scar, and
thus less incidence of rupture, than polyglactin. It would be
interesting to actually compare the incidence of uterine scar
rupture over different eras. Perhaps suturing the uterine wall
during myomectomy, when oestrogen and progesterone levels
are much lower than at the time of caesarean delivery, might be
another area to look at. Recent literature published in this
journal shows that myomectomy, especially through open
laparotomy, need not necessarily lead to offering an elective
ISSN 0144-3615 print/ISSN 1364-6893 online Ó 2009 Informa Healthcare USA, Inc.
Declaration of interest: The author reports no conflicts of
interest. The author alone is responsible for the content and
writing of the paper.
References
Bhattacharya R, Gobrial H, Barrington JW et al. 2008.
Psoas abscess after uncomplicated vaginal delivery: an
unusual case. Journal of Obstetrics and Gynaecology 28:544–
546.
Garagiola D, Tarver RD, Gibson L et al. 1989. Anatomic
changes in the pelvis after uncomplicated vaginal delivery: A
CT study on 14 women. American Journal of Roentgenology
153:1239–1241.
J. RAFI
Maternity and Child Health Department, Basingstoke and
North Hampshire NHS Trust, Basingstoke, UK
section as the risk of scar rupture is low (Kelly et al. 2008). No
information was given in this retrospective series about the
nature of suture used for closing the uterine wall and whether
the uterine cavity was opened or not. The author of this letter
encountered a case of successful vaginal delivery following open
myomectomy where the cavity was opened during removal of a
posterior uterine wall fibroid that encroached on the cervix. The
uterine wall was closed using Vicryl and the peritoneum was
closed using Prolene.
The authors are right to highlight the need to research wound
strength following different suture material, including chromic
catgut and polyglactin (Vicryl), and looking at the style of wound
closure. The author of this letter has long experience using two
layers of polyglactin (Vicryl) suture in a continuous knotted
fashion, taking a knot after taking a bite on the lower and
upper edges of the uterine incision, and believes this offers the
benefits of both continuous and interrupted sutures, although
 Letters to the editor 365

this has not been studied. It is hoped that the CAESAR study,
due for publication this year, will add some light on closure
techniques.
References
Kelly BA, Bright P, Mackenzie IZ. 2008. Does the surgical
approach used for myomectomy influence the morbidity in
subsequent pregnancy? Journal of Obstetrics and Gynaecology
28:77–81.
MacLean AB, MacLean SB. 2008. Suture materials and sub-
sequent wound strength. Journal of Obstetrics and Gynaecology
28:561–562.
S. ISMAIL
Department of Obstetrics and Gynaecology,
Yeovil District Hospital, Yeovil, UK

Correspondence: S. Ismail, Department of Obstetrics and Gynaecology, Yeovil District Hospital, Yeovil, UK.
E-mail: sharif212121@yahoo.co.uk

DOI: 10.1080/01443610902825370
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