Uterus-Preserving Treatment for Placenta Percreta by Reconstruction of the Lower Uterine Segment Using Wave Compression Suture: A Retrospective Cohort Study

Abstract Purpose To observe the hemostatic efficacy of reconstructing the lower uterine segment by wave compression sutures (WCSs) in patients with placenta previa who underwent cesarean section (CS). Methods Retrospective analysis the medical records with placenta previa underwent WCS at the West China Second University Hospital of Sichuan University.One-hundred-and-twenty-three women who received WCSs as the first uterine suture technique from January 1, 2016, to December 31, 2020, were included in this study. The hemostatic effect of WCS was compared according to the type of placenta previa and the intraoperative situation. All patients were followed up after CS. Results The hemostatic effect during CS and postpartum hemorrhage were observed. Seventy-two (58.5%) patients successfully achieved hemostasis without further intervention. Fifty-one (41.5%) cases required additional uterine artery ligation (UAL), cervical hanging maneuver (CHM), and Bakri tamponade. Seventy-nine cases exhibited thin anterior walls and lower uterine atony after placental dissection; of these, 72 (91.1%) obtained hemostasis by WCS. No patient required repeat laparotomy or hysterectomy. There were no complications attributable to the WCS following surgery. Among the five patients who had a second pregnancy, no intrauterine adhesions or abnormal uterine morphologies were caused by WCS. No ectopic or incision pregnancies occurred. Conclusions Reconstruction of the lower uterine segment by WCS is a suitable technique for patients with thin anterior walls and uterine atony of the lower uterine segment along with placenta previa. WCS is easy to perform, effective, and safe.

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Fahmy's four quadrant sutures: a new technique for control of blood loss during cesarean delivery for placenta previa

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183291 ◽

2018 ◽

Vol 7 (8) ◽

pp. 3004

Author(s):

Mohamed S. Fahmy ◽

Laila Ezzat ◽

Maraey M. Khalil ◽

Ahmed H. Elsayed ◽

Sherif S. Fahmy ◽

...

Keyword(s):

Blood Loss ◽

Cesarean Delivery ◽

Simple Procedure ◽

Placenta Previa ◽

Suture Technique ◽

University Hospital ◽

New Technique ◽

Artery Ligation ◽

The Mean ◽

Four Quadrant

Background: The objective of this study is to assess the efficacy and safety of Fahmy's four quadrant suture technique (FFQS) in controlling blood loss during cesarean delivery for placenta previa (PP).Methods: The study was carried out in a tertiary University Hospital between January 2017 to December 2017 involved 12 women with heavy bleeding occurred after removal of the placenta from the lower section during cesarean delivery for PP. The FFQS technique consisted of two sutures to ligate the uterine branches on both sides and two sutures on the anterior and posterior wall of the lower uterine segment. Details regarding the management and maternal outcomes were recorded.Results: The mean age of the study participants was 29.58±5.29 years and the mean parity was 2.25±1.14. The mean gestational age at termination of pregnancy was 36.91±1.38 weeks. The mean duration of the whole surgery was 78.75±43.28 minutes, while the mean duration of FFQS technique was only 10±2.09 minutes. The technique was exclusively effective in 8 out of 12 cases (66.67%) while 2 cases needed bilateral internal iliac artery ligation and 2 cases needed hysterectomy. The mean amount of blood loss in all cases was 2433.33±833.76 ml. the mean amount of transfused packed RBCs was 3.92±1.68 units and fresh frozen plasma (FFP) was 3.42±1.44 units. All cases had uneventful postoperative course and no mortality cases in present series.Conclusions: The new technique; FFQS represents a rapid, effective, and inexpensive opportunity for women with bleeding from the lower segment of uterus due to PP. This simple procedure should be attempted before other complex measures to achieve good hemostasis.

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A Different Method in the Treatment of Placenta Previa: A Comparison of Lower Uterine Segment Transverse Suture Technique and Bakri Balloon Application

Open Journal of Obstetrics and Gynecology ◽

10.4236/ojog.2019.93034 ◽

2019 ◽

Vol 09 (03) ◽

pp. 334-342

Author(s):

Gamze Savcı ◽

Ayse Z. Ozdemir ◽

Pervin Karlı ◽

İdris Kocak ◽

Yunus Katırcı ◽

...

Keyword(s):

Placenta Previa ◽

Suture Technique ◽

Lower Uterine Segment ◽

Bakri Balloon

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Uterine compression suture technique in the management of severe postpartum haemorrhage as an alternative to hysterectomy

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0912638s ◽

2009 ◽

Vol 137 (11-12) ◽

pp. 638-640 ◽

Cited By ~ 1

Author(s):

Dusan Stanojevic ◽

Marija Stanojevic ◽

Milena Zamurovic ◽

Anka Cirovic ◽

Amira Hajric ◽

...

Keyword(s):

Postpartum Haemorrhage ◽

Suture Technique ◽

Uterine Atony ◽

High Morbidity ◽

Excessive Bleeding ◽

Surgical Methods ◽

Extreme Measure ◽

Uterine Compression Suture ◽

Compression Suture ◽

Spontaneous Delivery

Introduction. One of the most dramatic conditions in obstetrics is definitely bleeding from the uterus which fails to compress. This condition is known as postpartum atony. When such a condition is diagnosed, the obstetrician has a choice of several conservative methods to stimulate the uterus to contract and several surgical methods to stop the bleeding. The most extreme measure used to save the patient's life and stop the bleeding is hysterectomy. This surgery is characterized by high morbidity, primarily by the loss of woman's fertility. In order to avoid hysterectomy, several authors have introduced the compressive uterine suture technique into gynaecological practice. Objective. The aim of the paper is to demonstrate the technique of applying compressive uterine suture after delivery to stop excessive bleeding, and to present results obtained by this technique. Methods. The paper explains the technique of applying compressive suture to the atonic uterus in cases when all other procedures to stop excessive bleeding after delivery fail. Since uterine atony is the main reason for excessive and uncontrollable bleeding after childbirth, the need to perform such surgery is rather common. Authors demonstrate the technique of applying four compressive sutures which prevent uterus dilation and thus stop the bleeding. Results. Compressive suture technique was used by the authors eight times, seven of which during caesarean section and one after spontaneous delivery. All patients had normal postpartum period and normal involution of the uterus. Conclusion. Although this surgery requires a skilful and experienced obstetrician, the authors find it rather easy to perform and it is suggested to be applied in all cases of uterine atony when excessive bleeding cannot be stopped by other any other method except hysterectomy. This surgical procedure saves the uterus and facilitates quick and easy patient's recovery.

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