Enclosing sutures technique for control of local bleeding in a case of placenta increta

Abstract

Antepartum diagnosis of uterine placenta increta is difficult, thus considering a counterplan during placental delivery is obliged. Uterine compression suture is one of the choices of hemostatic surgical techniques for postpartum hemorrhage. However, uterine synechiae/ischemia are known for the complications. To avoid these complications, we performed a novel hemostatic suture with a contrivance for a case of uterine posterior placenta increta. A nullipara with a history of multiple intrauterine operation underwent cesarean delivery. She was diagnosed as placental increta, and most of the placenta was removed manually. Because continuous bleeding from attachment site was observed even with a balloon tamponade test, four single sutures pierced only the uterine posterior wall with deliberate gaps to each knot were placed to enclose bleeding area. Hemostasis was accomplished without blood transfusion or hysterectomy. This novel hemostatic technique has the potential to control local bleeding without excessively reducing uterine blood flow.

Circular suture of the uterine serosa and myometrium layer around placental attachment site for refractory postpartum hemorrhage

“…This surgery stop the bleeding without penetrating the endometrium, affecting lochia discharge, avoiding intrauterine adhesion, and there is no change of menstruation in the patients during follow‐up. Compared with the previous modified surgical procedure, our suture method can avoid abdominal adhesion to a greater extent 31 …”

“…Compared with the previous modified surgical procedure, our suture method can avoid abdominal adhesion to a greater extent. 31 The incidence of severe PPH that could not be uncontrolled by drugs and traditional methods is relatively low. Therefore, when severe PPH occurs, they often do hysterectomy to save patients' lives in some primary hospitals because of the lack of relative equipment.…”

Hemostasis for Massive Hemorrhage during Cesarean Section

“…For severe hemorrhage from the surface of the placental separation in cases of placenta previa or placenta accreta, pressure hemostasis with gauze and suture hemostasis have been performed commonly, but these procedures are often unsuccessful in the presence of bleeding from a large area. Although separation of the bladder may be necessary on the anterior wall, the use of a simple suture or Z-suture, piercing the whole myometrium at several sites [3]; a large U-shaped suture; an interrupted circular suture consisting of repeated simple sutures in the entire circumference of the anterior and posterior walls [14]; and a suture of the muscular layer to block blood flow in four directions has been reported [3,14,15]. On the other hand, Bakri [16] reported that uterine balloon tamponade was effective for controlling hemorrhage from the surface of separation of the placenta previa.…”

A minimally invasive hemostatic strategy in obstetrics aiming to preserve uterine function and enhance the safety of subsequent pregnancies

“…When hemorrhage from the placental separation surface was severe, pressure hemostasis with gauze and suture hemostasis were commonly employed but often unsuccessful in cases with bleeding from a large area. Although separation of the bladder may be necessary on the anterior wall, the use of a simple suture or a Z-suture piercing the entire myometrium at several sites, a large U-shaped suture, enclosing sutures 21) and an interrupted circular suture 22) consisting of repeated simple suturing of the entire circumference of the anterior and posterior walls, have been reported.…”