Parallel transverse uterine incisions to control postpartum hemorrhage and preserve fertility during cesarean delivery for placenta previa and accreta

Conservative management of placental invasion anomalies with an intracavitary suture technique

“…7,19,20 Another conservative management approach involves leaving the placenta in situ; however, this strategy is associated with adverse effects, including delayed hemorrhage and infection. 13 Reduced blood loss in the present study reflected the fact that the bladder was not separated from the lower uterine segment in patients with placenta percreta after the uterine blood flow had ceased; consequently, bleeding from the branches of vesical arteries was prevented. 21,22 Likewise, a study that evaluated conservative non-extirpative methods reported severe morbidity among 10 patients and maternal death in one patient, with approximately one-third of all patients experiencing adverse events.…”

“…20 The mean estimated blood loss in the present study (1350 ± 750 mL) was lower than that previously reported (2000 mL [range 900-6500]). 13 Reduced blood loss in the present study reflected the fact that the bladder was not separated from the lower uterine segment in patients with placenta percreta after the uterine blood flow had ceased; consequently, bleeding from the branches of vesical arteries was prevented.…”

“…Consequently, surgical management of placental invasion anomalies should be individualized.No serious bleeding occurred in the present study cohort owing to interruption of the uterine and utero-ovarian blood flow before removal of the placenta. You et al13 reported a similar technique to the present study that involved a second uterine incision in the lower segment of the uterus, suggesting that such an approach offers the advantage of direct observation of the point of bleeding in the lower segment of the uterus. The findings of a randomized trial 12 suggested that preoperative placement of prophylactic balloon catheters did not affect the number of packed red blood cell units transfused among women with suspicion of placenta accreta.…”

“…Bladder suture b 8 (13) Admission to the intensive care unit 7 (11) Wound infection 3 (5) Endometritis c 2 (3) a Values are given as number (percentage), mean ± SD (range), and median (range).…”

Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa: A retrospective cohort analysis

“…Efficient hemostatic techniques should be performed to prevent PPH and preserve the uterus before, during and after CS. At present, there are many obstetric hemostatic techniques, such as abdominal aorta [19] or pelvic artery balloon occlusion [20][21] , cell salvage [22] , and modified surgical procedure [5,23] . BO (abdominal aorta or IIA) is the only technique that can be employed before CS in patients who need to keep the uterus and reserve fertility.…”