Parallel vertical compression sutures in the lower uterine segment to control bleeding from major placenta previa or accrete during caesarean section

Abstract

Objective The common types of compression sutures are less effective with abnormal placentation. In this study, we reported our experience with the use of two parallel vertical compression sutures over the lower uterine segment for cases of major placenta previa and accreta. This is the largest series reported on the use of this type of compression sutures. Methods Clinical details for cases of major placenta previa with parallel vertical compression sutures applied during caesarean section were collected and reviewed. Results Twenty-eight women with major placenta previa (including 2 with accreta) had parallel vertical compression sutures inserted during caesarean delivery. It was successfully applied for both term and preterm uterus (from 30 to 39 weeks) and in both elective (15 cases) and in emergency settings (13 cases). Bleeding immediately decreased and all successfully had their uterus conserved. In 17 cases, major postpartum haemorrhage (>=1000ml) was prevented. In 79% of cases (22/28), it was performed by trainee under supervision, 45% (10/22) without assistance by consultant. B-lynch sutures were applied in addition in three cases and uterine artery embolisation for the two cases of accreta. All had normal return of menstruation. Conclusion In women with major placenta previa or accreta, two vertical compression sutures placed in the lower uterine segment are an easy and effective way for rapid control of massive bleeding, and should be considered first-line surgical measure.