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Compression Sutures
for Critical Hemorrhage
During Cesarean Section
A Guide by CG Animation
Satoru Takeda
Shintaro Makino
Editors
123
Compression Sutures for Critical
Hemorrhage During Cesarean Section
Satoru Takeda • Shintaro Makino
Editors
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
Preface
v
vi Preface
that the thoughts of obstetricians with extensive experience treating critical hemor-
rhage in obstetrics can be read between the lines and that this book will help our
readers to reduce maternal mortality, even if only modestly, in their future clinical
practice.
vii
History of Surgical Remedies
for Obstetrical Uterine Hemorrhage 1
Satoru Takeda and Yasuhisa Terao
Abstract
Arterial ligation and stepwise uterine devascularization were formerly used as
hemostatic techniques to control massive hemorrhage during cesarean section
without hysterectomy and to preserve the uterus. However, depending on the
sites of arterial ligation, the hemostatic effect was often inadequate because of
collateral circulation. Subsequently, insufficient blood flow and ischemia in the
preserved uterus caused ovarian dysfunction and endometrial growth impair-
ment, (e.g., hypomenorrhea, oligomenorrhea, amenorrhea, and infertility).
Furthermore, it has been recognized that subsequent pregnancies can be compli-
cated by premature labor, spontaneous abortion, placenta accreta, etc. At present,
arterial ligation is not performed.
In place of this technique, various compression sutures, including the B-Lynch
suture which was first reported in 1997, are the current mainstream hemostatic
techniques for uterine hemorrhage during cesarean section and are widely used
in clinical practice. Moreover, Bakri et al. reported favorable hemostatic out-
comes when managing hemorrhage from placenta previa and placenta previa
accreta by balloon tamponade. This technique is used for hemostasis in uterine
hemorrhage not only during cesarean section but also after vaginal delivery. The
hemostatic techniques in use have recently undergone diversification, including
application of a combination of intrauterine compression hemostasis and balloon
tamponade and intraoperative arterial embolization, performed in a hybrid oper-
ating room.
Keywords
Critical uterine hemorrhage · Cesarean section · Compression sutures · Uterine
balloon tamponade · Interventional radiology · Arterial embolization · Arterial
balloon occlusion · Damage control
1.1 Introduction
Intrauterine gauze packing and uterine balloon tamponade have been performed
for postpartum uterine hemorrhage that is difficult to control [6]. However,
because these conservative treatment techniques have limits, surgical hemostasis
1 History of Surgical Remedies for Obstetrical Uterine Hemorrhage 3
When hemostasis is performed for uterine hemorrhage during cesarean section, the
abdomen is already open. In this state, because hysterectomy can be performed in
the worst case situations, surgical hemostatic techniques are also easy to perform
[10]. However, because massive hemorrhage is expected in cases, such as placenta
previa accreta, placenta increta, and placenta percreta, hemostatic techniques have
been attempted and studied under various conditions, taking into account general
clinical states and factors (e.g., severity of hemorrhage, disease, and hemorrhagic
tendency) and the presence or absence of fertility in various cases.
Arterial ligation, including ligation of the internal iliac artery, has a limited hemo-
static effect and is less effective in cases with abundant blood flow from the external
iliac artery, such as placenta previa accreta [11]. On the other hand, stepwise uterine
devascularization, in which the feeding vessels of the uterus are sequentially ligated,
has a relatively high hemostatic effect [9]. However, even if the uterus is preserved,
insufficient blood flow and uterine ischemia might cause ovarian dysfunction and
4 S. Takeda and Y. Terao
References
1. Matsunaga S, Seki H, Ono Y, Matsumura H, Murayama Y, Takai Y, Saito M, Takeda S, Maeda
H. A retrospective analysis of transfusion management for obstetric hemorrhage in a Japanese
obstetric center. ISRN Obstet Gynecol. 2012;2012. Article ID 854064, 8 pages. https://doi.
org/10.5402/2012/854064.
2. Makino S, Takeda S, Kobayashi T, Murakami M, Kubo T, Hata T, Masuzaki H. National sur-
vey of fibrinogen concentrate usage for post-partum hemorrhage in Japan: investigated by the
Perinatology Committee, Japan Society of Obstetrics and Gynecology. J Obstet Gynaecol Res.
2015;41(8):1155–60. https://doi.org/10.1111/jog.12708.
3. Matsunaga S, Takai Y, Nakamura E, Era S, Ono Y, Yamamoto K, Maeda H, Seki H. The clini-
cal efficacy of fibrinogen concentrate in massive obstetric haemorrhage with hypofibrinogen-
aemia. Sci Rep. 2017;7:46749.
4. Takeda S, Makino S, Takeda J, Kanayama N, Kubo T, Nakai A, Suzuki S, Seki H, Terui K,
Inaba S, Miyata S. Japanese clinical practice guide for critical obstetrical hemorrhage (2017
revision). J Obstet Gynaecol Res. 2017;43(10):1517–21.
5. Sone M, Nakajima Y, Woodhams R, Shioyama Y, Tsurusaki M, Hiraki T, Yoshimatsu M,
Hyodoh H, Kubo T, Takeda S, Minakami H. Interventional radiology for critical hemorrhage
in obstetrics: Japanese Society of Interventional Radiology (JSIR) procedural guidelines. Jpn
J Radiol. 2015;33(4):233–40. https://doi.org/10.1007/s11604-015-0399-0.IVR.
6. Georgiou C. A review of current practice in using balloon tamponade technology in the man-
agement of postpartum haemorrhage. Hypertens Res Pregnancy. 2014;2:1–10.
7. Waters EG. Surgical management of postpartum hemorrhage with particular reference to liga-
tion of uterine arteries. Am J Obstet Gynecol. 1952;64:1143–8.
8. O’Leary JL, O’Leary JA. Uterine artery ligation in the control of intractable postpartum hem-
orrhage. Am J Obstet Gynecol. 1966;94:920–4.
9. AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of
uncontrolled post-partum hemorrhage with preservation of the uterus. Am J Obstet Gynecol.
1994;171:694–700.
10. Makino S, Hirai C, Takeda J, Yorifuji T, Itakura A, Takeda S. Hemostatic technique during
cesarean section. Hypertens Res Pregnancy. 2016;4:6–10.
11. Iwata A, Murayama Y, Itakura A, Baba K, Seki H, Takeda S. Limitations of internal iliac artery
ligation for the reduction of intraoperative hemorrhage during cesarean hysterectomy in cases
of placenta previa accreta. J Obstet Gynaecol Res. 2010;36(2):254–9.
12. B-Lynch C, Coker A, Lawal AH, et al. The B-Lynch surgical technique for the control of mas-
sive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet
Gynaecol. 1997;104:372–5.
13. Hwu YM, Chen CP, Chen HS, et al. Parallel vertical compression sutures: a technique
to control bleeding from placenta praevia or accreta during caesarean section. BJOG.
2005;112:1420–3.
14. Makino S, Takeda S, Yorifuji T, et al. Double vertical compression sutures: a novel conser-
vative approach to managing post-partum haemorrhage due to placental praevia and atonic
bleeding. Aust N J Obstet gynaecol. 2012;52:290–2.
15. Tanaka T, Makino S, Yorifuji T, Saito T, Koshiishi T, Tanaka S, Ota A, Takeda S. Vertical
compression sutures for control of postpartum hemorrhage from a placenta previa in cesarean
section—to evaluate the usefulness of this technique. Hypertens Res Pregnancy. 2014;2:21–5.
16. Takeda J, Hiranuma K, Hirayama T, Makino S, Itakura A, Takeda S. The use of medial, wider
vertical compression sutures to reduce uterine blood flow for effaced uterine isthmus: a case
report. J Obstet Gynaecol. 2018;38(6):871–3. https://doi.org/10.1080/01443615.2017.1387522.
17. Takeda J, Makino S, Matsumura Y, Itakura A, Takeda S. Enclosing sutures technique for con-
trol of local bleeding in a case of placenta increta. J Obstet Gynaecol Res. 2018;44(8):1472–5.
https://doi.org/10.1111/jog.13670.
18. Bakri YN, Amri A, Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding. Int J Gynecol
Obstet. 2001;74:139.
1 History of Surgical Remedies for Obstetrical Uterine Hemorrhage 9
Abstract
Uterine compression suture is a simple and effective hemostatic procedure that
requires no special skills. It can be performed in a primary medical institution
even in cases which need to be transferred. The implementation of TAE and arte-
rial ligation should be limited to cases with failure of local hemostatic proce-
dures (e.g., balloon tamponade and compression suture) in consideration of their
adverse effects. It is important that each institution has relevant protocols in
place. Keep in mind that DIC treatment is the top priority while performing dam-
age control, as described in Chapter 1.
Keywords
Atonic bleeding · Balloon tamponade · B-Lynch suture · Uterine compression
sutures · TAE
2.1 Introduction
Although there are various causes of bleeding during cesarean section, they are
roughly divided into two types, i.e., bleeding from the separated surface of the pla-
centa and atonic bleeding. The amount of bleeding depends on the time required for
identification of the cause of bleeding, treatment, and suturing of the myometrium.
Doctors should have full knowledge of hemostatic techniques and their procedures
in advance in order to take prompt action to prevent secondary atonic bleeding due
to massive bleeding.
The prognosis of massive bleeding is dependent on how quickly the cause of bleed-
ing is identified, proper measures are implemented against it, and in cases of cesar-
ean section myometrial suture is completed. Because continuous bleeding may
cause secondary atonic bleeding, it is necessary to immediately choose the most
suitable method of hemostasis once massive bleeding takes place.
Hemostatic methods are roughly divided into local hemostasis and blockade of
blood flow or ligation of blood vessels by TAE, devascularization, etc. Regardless
of which type of hemostasis is chosen, it is important to make a choice based
on a good understanding of adverse effects and complications of the hemostatic
method. Local hemostatic measures include gauze compression, Z-suture, balloon
2 Uterine Compression Sutures for Atonic Bleeding 13
tamponade, the modified B-Lynch suture, and vertical compression suture. As com-
plications of these procedures, injuries to surrounding organs such as the bladder
and rectum may occur. On the other hand, arterial ligation and TAE, which block
blood flow into the uterus, may induce a wider variety of complications in com-
parison with local hemostasis [2]. Post-procedural complications include uterine
infection, myometrial necrosis, Asherman syndrome, menstrual abnormalities, such
as hypomenorrhea and oligomenorrhea, poor endometrial development, and infer-
tility. In addition, serious adverse effects, such as abortion, uterine rupture, placenta
accreta, and postpartum hemorrhage, may occur at the time of subsequent preg-
nancy. Therefore, blockade of blood flow and ligation should be implemented only
when compression suture, balloon tamponade, and other hemostatic measures have
failed to control bleeding.
isthmus vertical compression sutures were effective for stopping bleeding from
the uterine isthmus and uterine body [9].
The major hemostatic mechanism of uterine compression suture was formerly
considered to be compression by suture. However, we previously assessed changes
in uterine artery flow before and after uterine compression suture by ultrasound
tomography and found that the blood flow rate decreased, and the resistance index
(RI) increased, after suturing. In general, 90% of the blood supply to the pregnant
uterus comes from the uterine artery. Therefore, it is presumed that uterine compres-
sion suturing exerts two actions, i.e., hemostasis by compression of the bleeding
surface and reduction of the uterine blood flow.
However, they are associated with the risk of uterine ischemia; thus, in a patient
who experiences excessive abdominal pain after receiving vertical compression
sutures, the need for uterine blood perfusion must be assessed. When uterine isch-
emia is found, removal of the compression sutures should be considered [11].
Based on these findings, uterine compression suturing is a hemostatic method
that should be mastered by doctors, particularly those working in institutions where
TAE is not immediately feasible.
significantly more common in the UCS than in the non-UCS group (8/39 [20.5%]
vs 4/37 [10.8%]; P = 0.021), but the frequency of ileus did not differ (1/39 [2.6%]
vs 2/37 [5.4%]; P = 0.61) [15].
2.5 Conclusion
References
1. B-Lynch C, Cocker A, Lawal AH, et al. The B-Lynch surgical technique for the control of mas-
sive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet
Gynecol. 1997;104:325–7.
2. Takeda S, Takeda J, Makino S. A minimally invasive hemostatic strategy in obstetrics aiming
to preserve uterine function and enhance the safety of subsequent pregnancies. Hypertens Res
Pregnancy. 2019;7(1):9–15. https://doi.org/10.14390/jsshp.HRP2018-013.
3. Shih JC, Liu KL, Kang J, Yang JH, Lin MW, Yu CU. ‘Nausicaa’ compression suture: a sim-
ple and effective alternative to hysterectomy in placenta accreta spectrum and other causes of
severe postpartum haemorrhage. BJOG. 2019;126:412–7.
4. Takahashi H, Baba Y, Usui R, Suzuki H, Horie K, Yano H, Ohkuchi A, Matsubara S. Matsubara-
Yano suture: a simple uterine compression suture for postpartum hemorrhage during cesarean
section. Arch Gynecol Obstet. 2019;299:113–21.
5. Matsuzaki S, Endo M, Tomimatsu T, Nakagawa S, Matsuzaki S, Miyake T, Takiuchi T, Kakigano
A, Mimura K, Ueda Y, Kimura T. New dedicated blunt straight needles and sutures for uterine
compression sutures: a retrospective study and literature review. BMC Surg. 2019;19:33.
6. Kaya B, Tuten A, Daglar K, Onkun M, Sucu S, Dogan A, Unal O, Guralp O. B-Lynch uterine
compression sutures in the conservative surgical management of uterine atony. Arch Gynecol
Obstet. 2015;291:1005–14.
16 S. Makino and S. Takeda
7. Şahin H, Soylu Karapınar O, Şahin EA, Dolapçıoğlu K, Baloğlu A. The effectiveness of the
double B-lynch suture as a modification in the treatment of intractable postpartum haemor-
rhage. J Obstet Gynaecol. 2018;38:796–9.
8. Makino S, Tanaka T, Yorifuji T, Koshiishi T, Sugimura M, Takeda S. Double vertical com-
pression sutures: a novel conservative approach to managing post-partum hemorrhage due to
placenta previa and atonic bleeding. Aust N Z J Obstet Gynaecol. 2012;52:290–2.
9. Tanaka T, Makino S, Yorifuji T, Saito T, Koshiishi T, Takeda S. Vertical compression sutures
for control of postpartum hemorrhage from a placenta previa in cesarean section to evaluate
the usefulness of this technique. Hypertens Res Pregnancy. 2014;2:21–5.
10. Mavrides E, Allad S, Chandraharan E, Collins P, Green L, Hunt BJ, et al. Prevention and
management of postpartum haemorrhage: green-top guideline no. 52. Int J Obstet Gynaecol.
2017;124:106–49.
11. Takeda J, Kumakiri J, Makino S, Itakura A, Takeda S. Laparoscopic removal of uterine vertical
compression sutures. Gynecol Minim Invasive Ther. 2017;6:73–5.
12. Takeda J, Makino S, Takeda S. Hemostasis for massive hemorrhage during cesarean section.
In: Cesarean delivery. IntechOpen; 2019 (in press).
13. Takeda S, Makino S, Takeda J, Kanayama N, Kubo T, Nakai A, Suzuki S, Seki H, Terui K,
Inaba S, Miyata S. Japanese clinical practice guide for critical obstetrical hemorrhage (2017
revision). J Obstet Gynaecol Res. 2017;43:1517–21.
14. An GH, Ryu HM, Kim MY, et al. Outcomes of subsequent pregnancies after uterine compres-
sion sutures for postpartum hemorrhage. Obstet Gynecol. 2013;122:565–70.
15. Suzuki Y, Matsuzaki S, Mimura K, Kumasawa K, Tomimatsu T, Endo M, Kimura
T. Investigation of perioperative complications associated with use of uterine compression
sutures. Int J Gynaecol Obstet. 2017;139:28–33.
Double Vertical Compression Sutures
3
Shintaro Makino
First, the bilateral cut ends of the uterine incision should be ligated, and bleeding
from the ascending branches of the uterine artery is to be stopped. Second, after
confirming that the bladder is sufficiently detached downwards, the needle thread
should pierce the uterus from the anterior wall to the posterior wall at a stroke below
the lateral side of the incision while paying attention to the rectum. On the contralat-
eral side, the needle thread is passed in the same manner, and ligation is performed
on the right and left sides of the uterine fundus while having an assistant compress
the uterus with both hands.
S. Makino (*)
Department of Obstetrics and Gynecology, Faculty of Medicine,
Juntendo University, Bunkyo-ku, Tokyo, Japan
e-mail: shintaro@juntendo.ac.jp
If blood is flowing outward from the separated surface of placenta previa, double
vertical compression suture combined with compression suture in the uterine cervix
should be performed to stop the bleeding. This method is also applicable to cases
of concomitant atonic bleeding after massive bleeding. We use 90 cm of Vicryl
Rapide® 1 (Ethicon, Tokyo), which dissolves in a few days, for uterine compres-
sion suture to prevent postoperative complications such as uterine cavity adhesion.
This allows reduction of the duration of uterine compression and decreases the risk
of menstrual disorder or implantation disorder resulting from deformation of the
uterus.
References
1. B-Lynch C, Cocker A, Lawal AH, et al. The B-Lynch surgical technique for the control of mas-
sive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet
Gynecol. 1997;104:325–7.
2. Hayman RG, Arulkumaran S, Steer PJ. Uterine compression sutures: surgical management of
postpartum hemorrhage. Obstet Gynecol. 2002;99:502–6.
3. Makino S, Tanaka T, Yorifuji T, Koshiishi T, Sugimura M, Takeda S. Double vertical com-
pression sutures: a novel conservative approach to managing post-partum hemorrhage due to
placenta previa and atonic bleeding. Aust N Z J Obstet Gynaecol. 2012;52:290–2.
Vertical Compression Sutures
with Contrivances 4
Jun Takeda
Abstract
Postpartum hemorrhage is one of the leading causes of maternal morbidity and
mortality. Several hemostatic surgical techniques during cesarean section as
typified by B-Lynch sutures and Hyman sutures (see Chap. 2) have been reported
previously (B-Lynch et al., Br J Obstet Gynecol 104: 372–375, 1997; Hayman
et al., Obstet Gynecol 99: 502–506, 2002). Among them, vertical compression
sutures (Makino et al., Aust N Z J Obstet Gynecol 52: 290–292, 2012) are an
effective and easy way of achieving hemostasis during cesarean section and
now cited in BJOG Guidelines (Mavrides et al., BJOG 124: e106–e149, 2017).
However, in particular cases, it is difficult to achieve hemostasis only with the
compression sutures. In such cases, it needed contrivances to achieve hemosta-
sis and to act against complication as practical applications of compression
sutures. In this chapter, modifications of vertical compression sutures are
described.
Keywords
Complication · Compression sutures · Contrivance · Enclosing sutures · Medial
and wider compression sutures · Modification · Uterine balloon tamponade
4.1 Introduction
For the original method of the double vertical compression sutures, threads were
placed through the anterior wall and posterior wall of the uterus and compress the
uterine cavity by apposing the anterior and posterior walls [1]. It originally aims to
J. Takeda (*)
Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University,
Bunkyo-ku, Tokyo, Japan
e-mail: jtakeda@juntendo.ac.jp
© Springer Nature Singapore Pte Ltd. 2020 19
S. Takeda, S. Makino (eds.), Compression Sutures for Critical Hemorrhage
During Cesarean Section, https://doi.org/10.1007/978-981-32-9460-8_4
20 J. Takeda
cease uterine bleeding during elective cesarean section for placenta previa. Some
contrivances aided compression sutures for the reliable hemostasis and minimal
invasive procedure.
4.2 Conclusion
References
1. Makino S, Tanaka T, Yorifuji T, Koshiishi T, Sugimura M, Takeda S. Double vertical com-
pression sutures: a novel conservative approach to managing postpartum hemorrhage due to
placenta previa and atonic bleeding. Aust N Z J Obstet Gynecol. 2012;52:290–2.
2. Takeda J, Tanaka K, Ohashi R. Uterine isthmus vertical compression suture for controlling
uterine corpus bleeding: a possible mechanism of decreasing uterine blood flow. Hypertens Res
Pregnancy. 2016;4:45.
3. Takeda J, Hiranuma K, Hirayama T, Makino S, Itakura A, Takeda S. The use of medial, wider
vertical compression sutures to reduce uterine blood flow for effaced uterine isthmus: a case
report. J Obstet Gynaecol. 2018;38:871–3.
4. Takeda J, Makino S, Matsumura Y, Itakura A, Takeda S. Enclosing sutures technique for con-
trol of local bleeding in a case of placenta increta. J Obstet Gynaecol Res. 2018;44:1472–5.
Compression Sutures Removal
5
Jun Takeda
Abstract
The mechanisms of achieving hemostasis with uterine compression sutures are
compressing the bleeding site and reduction of uterine blood flow. Thus, when
the excessive reduction of uterine blood flow happened, uterine ischemia or
necrosis may occur as the complications. In such a case, local pain which is dif-
ficult to control with general analgesics such as non-steroidal anti-inflammatory
drugs and acetaminophen may occur. As a countermeasure, removing uterine
compression sutures should be considered. Specialized suturing technique
assuming threads removal has been reported, but laparoscopic surgery should be
considered as it can accommodate any compression sutures and is less invasive
than abdominal surgery.
Keywords
Analgesic · Complication · Compression sutures · Laparoscopic surgery · Thread
removal · Uterine ischemia · Uterine necrosis
5.1 Introduction
Uterine compression sutures are now widely accepted for hemostasis during cesar-
ean section. Above all, B-Lynch suturing is one of the most well-known methods
for controlling postpartum hemorrhage [1]. Several different types of compression
sutures techniques have been developed since then (see Chap. 2). Although uterine
compression sutures did not appear to adversely affect the menstrual and fertility
J. Takeda (*)
Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University,
Bunkyo-ku, Tokyo, Japan
e-mail: jtakeda@juntendo.ac.jp
outcomes in most women [2], still cases of uterine necrosis and synechiae have been
reported [3–7]. To avoid these complications, compression suture removal should
be considered.
5.2 Conclusion
OTHELLO’S APOLOGY
[The speech calls for great dignity, ease, and power, in both speech
and manner.]
Most potent, grave, and reverend signiors,
My very noble and approved good masters,
That I have ta’en away this old man’s daughter,
It is most true; true, I have married her:
The very head and front of my offending
Hath this extent, no more. Rude am I in my speech,
And little bless’d with the soft phrase of peace;
For since these arms of mine had seven years’ pith,
Till now some nine moons wasted, they have used
Their dearest action in the tented field,
And little of this great world can I speak,
More than pertains to feats of broil and battle,
And therefore little shall I grace my cause
In speaking for myself. Yet, by your gracious patience,
I will a round unvarnish’d tale deliver
Of my whole course of love; what drugs, what charms,
What conjuration, and what mighty magic,—
For such proceeding I am charg’d withal,—
I won his daughter.
...
Her father loved me; oft invited me;
Still question’d me the story of my life,
From year to year,—the battles, sieges, fortunes,
That I have pass’d.
I ran it through, even from my boyish days,
To the very moment that he bade me tell it:
Wherein I spake of most disastrous chances,
Of moving accidents by flood and field,
Of hair-breadth scapes i’ the imminent deadly breach,
Of being taken by the insolent foe
And sold to slavery, of my redemption thence
And portance in my travels’ history:
...
This to hear
Would Desdemona seriously incline:
But still the house-affairs would draw her thence;
Which ever as she could with haste despatch,
She’d come again, and with a greedy ear
Devour up my discourse: which I observing,
Took once a pliant hour, and found good means
To draw from her a prayer of earnest heart
That I would all my pilgrimage dilate,
Whereof by parcels she had something heard,
But not intentively: I did consent,
And often did beguile her of her tears,
When I did speak of some distressful stroke
That my youth suffer’d. My story being done,
She gave me for my pains a world of sighs:
She swore, in faith, ’twas strange, ’twas passing strange,
’Twas pitiful, ’twas wondrous pitiful:
She wish’d she had not heard it, yet she wish’d
That heaven had made her such a man: she thank’d me,
And bade me, if I had a friend that loved her,
I should but teach him how to tell my story,
And that would woo her. Upon this hint I spake:
She loved me for the dangers I had pass’d;
And I lov’d her that she did pity them.
This only is the witchcraft I have used.
...
Lady Capulet.
Juliet.
Good night;
Get thee to bed and rest, for thou hast need.
CORYDON
By Thomas Bailey Aldrich
SCENE, A ROAD-SIDE IN ARCADY
Pilgrim. A poet.
Shepherd. Nay, a simple swain
That tends his flocks on yonder plain
Naught else I swear by book and bell.
But she that passed you marked her well
Was she not smooth as any be
That dwells here—in Arcady?