Parallel Loop Binding Compression Suture, a Modified Procedure for Pernicious Placenta Previa Complicated With Placenta Increta

Objective: To evaluate the efficacy and safety of parallel loop binding compression suture of the lower uterus during cesarean section in pernicious placenta previa complicated with placenta increta.Methods: This retrospective study was performed in patients with pernicious placenta previa complicated with placenta increta or percreta between November 2014 and December 2020 at the Qilu Hospital of Shandong University. Patients underwent parallel loop binding compression suture surgery were defined as study group, and patients underwent traditional surgery with figure-of-eight sutures as the main hemostatic method were defined as control group. Postpartum hemorrhage was evaluated as the primary outcome. The secondary outcomes included age, gestational weeks, operative time, fetal childbirth time, prevention of hysterectomy, blood transfusion, duration of postoperative catheterization, duration of antibiotic treatment, and postoperative hospitalization (days). Additionally, neonatal outcomes were evaluated.Results: A total of 124 patients were enrolled in the study, including 38 patients receiving parallel loop binding compression suture surgery in the study group, and 86 patients in the control group. With parallel loop binding compression suture, the average operation time was significantly reduced (109.0 ± 33.5 vs. 134.4 ± 54.2 min, p = 0.00), and the volume of blood lost were also decreased (2152.6 ± 1169.4 vs. 2960.5 ± 1963.6 ml, p = 0.02), which correspondingly reduced RBC transfusion (7.2 ± 3.5 vs. 10.3 ± 8.7 units, p = 0.03) and FFP transfusion (552.6 ± 350.3 vs. 968.0 ± 799.8 ml, p = 0.00). The fetal childbirth time was extended (14.1 ± 5.6 vs. 11.0 ± 8.0 min, p = 0.03), however, there was no increase in NICU admission rates (36.9 vs. 34.9%, p = 0.83). Except for one premature infant (32 weeks) death in the control group, all infants at our hospital were safely discharged after treatment.Conclusion: Parallel loop binding compression suture is an effective, swift, practical, and safe method to reduce postpartum bleeding in women with pernicious placenta previa, complicated with placenta increta. Besides, it has no adverse effects on newborns.

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

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.

Parallel loop binding compression suture, a modified procedure for pernicious placenta previa complicated with placenta increta: a retrospective study. (with video)

Objective. To evaluate the efficacy and safety of parallel loop binding suture of the lower uterus during cesarean section in pernicious placenta previa complicated with placenta increta. Design. A retrospective study Setting. Qilu Hospital of Shandong University Population. Patients with pernicious placenta previa between November 2014 and December 2020 at the Qilu Hospital of Shandong University were eligible. Methods. The degree of placental invasion was evaluated using preoperative color Doppler ultrasonography and/or magnetic resonance imaging (MRI). Main outcome measures. Postpartum hemorrhage was evaluated as the primary outcome. Additionally, neonatal outcomes were evaluated. Results. Of the 38 patients, only 3 (7.89%) underwent hysterectomy due to massive blood loss. With parallel loop binding compression suture, the volume of blood lost ranged from 500 - 6000 (mean: 2152.63±1169.37) mL and the volume of blood transfused was between 400 - 3200 (1431.58±699.85) mL. The mean gestational age was 36 weeks and 2 days (range: 32+6 to39+6 weeks). The average operation time was 109.78 ± 33.49 min, and the average fetal childbirth time was 14.05±5.60 min. The rate of NICU admission was 36.84% (14/38). The postoperative menstrual cycle and menstrual flow both returned to normal levels. All infants at our hospital were safely discharged after treatment. Conclusion. Parallel loop binding compression suture is an effective, swift, practical, and safe method to reduce postpartum bleeding in women with pernicious placenta previa, complicated with placenta increta.

A case report on decidual cast following B-lynch compression suture

In case of atonic postpartum haemorrhage (PPH) and traumatic PPH or cervical tear extended deep up to lower uterine segment exploratory laparotomy is the last resort to control PPH. It was a case of 20 years old female admitted in labour room with chief complain of bleeding per vaginum and something coming out of vagina after 6 weeks of post laprotomy for atonic postpartum hemorrhage. Compression sutures were applied and bilateral uterine artery ligation was done at time of laparotomy. After 6 weeks post laparotomy the patient was presented with complain of something coming out from vagina. An examination was performed under short general anesthesia in the operation theater, the mass was removed without any resistance. A provision diagnosis of decidual cast was made which was later confirmed by histopathological report which shows autolytic changes in decidual tissue. Women which are undergoing bilateral uterine artery ligation or compression suture for management of postpartum hemorrhage, should be informed about potential complication. Postoperative follow-up is necessary for any complications.

Comparative Study between Modified Transverse and Hayman Suture Regarding the Efficacy and Purperium Complications in Thi-Qar

Background: Main causes of death post-partum is the uncontrolled hemorrhage, that managed by different modalities, whereuterine compression suture had different efficacies as a main interventional tools of sever postpartum hemorrhage. Aim: comparing different sutures types (modified transverse and Hayman suture) regarding their efficacy through its impact and in determining the final outcome and complications of post-partum hemorrhage. Materials and methods: A prospective comparative analytical study including 122 females , who underwent delivery between march 2017and December 2019, all of them followed for , 1 week, 6,weeks 6 months. Were the samples collected from Bent-Al-Huda teaching hospital and Al-Rehman private hospital-Thi-Qar, 2 groups of study; 1st one (52) underwent modified B-lynch suturing (Hyman suturing) while the 2nd group(70) underwent transverse sutures of modified Ouahba suture, written consent had taken from all patients, SPSS version 24 used for analysis. Results: Among 122 delivered women suffer from primary post-partum hemorrhage, 52 (42.63%) were sutured by Hayman suture, and 70 (57.37%)were sutured by transverse suturing,There was significant statistical difference between the types of intervention and blood loss P value <0.05. There was significant statistical difference between the types of intervention and complication development (p value=0.0001). There was no significant independent predictors or determinant for the complication development except the type of intervention. Only follow-up period and complication were truly to be correlated with type of intervention, the other variable were confounders Conclusion: Even though the hemostasis had been achieved in both maneuver with excellent success rate, the transvers suture carrying high rate of persistent pain but the Hayman suture carry higher rate of serious complication such hysterectomy and intestinal obstruction. several factors determine the choosing of the suture type such as site, severity and cause of bleeding and the surgeon experience.