Contemporary Approaches to Postpartum Hemorrhage with Focus on Uterine Compression Sutures—An Updated Comprehensive Systematic Review

Background/Objectives: Surgical management of postpartum hemorrhage (PPH) is essential when conservative measures fail, yet no clear hierarchy of effectiveness among interventions exists. Given the scarcity of the direct comparative studies and the substantial clinical and methodological heterogenicity of the available evidence, this systematic review aims to provide an updated and structured synthesis of the UCS for the management of refractory PPH. Methods: We reviewed studies published from January 2014 to December 2025 using keywords related to PPH and UCS. After excluding duplicates and applying the inclusion and exclusion criteria, we selected 31 articles. Results: We grouped the selected articles into 4 sections: UCS alone; UCS versus uterine artery embolization (UAE) and versus Bakri balloon tamponade; newer UCS techniques; and articles on future fertility outcomes after UCS. Evidence on UCS alone was predominantly uncontrolled observational case series, with reported efficacy ranging from 73.9% to 100%. Newer UCS techniques use removable sutures to reduce side effects and complications. Although early results on subsequent fertility and menstrual function appear promising, the lack of large, well-designed randomized studies warrants caution in interpretation. Conclusions: Asian tertiary centers dominate the literature and report high uterine preservation rates, but retrospective design, small samples, lack of controls, inadequate adjustment for confounders, and heterogeneous techniques limit the strength of conclusions and generalizability. The predominance of cesarean section cohort further limits generalizability to vaginal births. UCS efficacy appears strongly influenced by bleeding severity and case complexity.