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• W2087407265 abstract "Severe bleeding sometimes complicates removal of the placenta in women with placenta previa whether or not placenta accreta is also present. Traditional treatments include hypogastric artery ligation and cesarean hysterectomy. Hypogastric artery ligation is a difficult procedure and, if not successful, may lead to ureteral injury or cardiac arrest. Cho et al recently described a square suturing technique that compresses the anterior and posterior uterine walls to control postpartum bleeding. Four stitches are needed to form the square. A version now has been devised that substitutes simple vertical sutures for the square suturing method. Only one stitch is needed. Fourteen women with postpartum bleeding from placenta previa had the modified operation in the past few years. Hemostasis was achieved with vertical compression sutures placed in the lower uterine segment. After cesarean section using a Pfannenstiel incision, the placenta is removed and the bladder reflected downward behind a retractor. A no. 1 chromic catgut, 40-mm curved, round suturing needle is used to make a stitch through the anterior wall of the lower uterine segment approximately 3 cm medial to the right margin of the lower segment and 2 to 3 cm above the upper margin of the cervix. The incised edge of the anterior lower segment then is pulled forward and up to expose the lower segment uterine cavity. From inside the uterine cavity, the suture is threaded through the lower segment cavity and inserted into the middle layer of the posterior wall of the lower segment 2 to 3 cm above the upper cervical margin. The needle then is directed vertically upward about 3 to 4 cm within the middle layer of the posterior wall and pulled from back to front through the uterine cavity and anterior wall of the lower segment, exiting approximately 2 to 3 cm below the uterine incision. Another no. 1 chromic catgut needle is used in the same way to place a suture approximately 3 cm medial to the left edge of the lower segment. The sutures are knotted as tightly as possible to compress the lower segment of the uterine cavity. The uterine incision is closed in the usual manner. Blood loss in the 14 women having this operation ranged from 700 to 2500 mL, but there was a progressive decline in bleeding when surgery was done immediately when bleeding could not be controlled. The compression sutures caused no complications, and ultrasound studies done 3 days postoperatively showed no blood accumulating in the uterine cavity. At 1 month, all women had a patent uterine cavity. Subsequent menstrual flow was normal. Two women became pregnant 1 to 2 years after surgery. This is an effective, rapid, and relatively easily performed operation that controls bleeding in women with placenta previa or placenta accreta." @default.
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• W2087407265 date "2006-02-01" @default.
• W2087407265 modified "2023-09-26" @default.
• W2087407265 title "Parallel Vertical Compression Sutures: A Technique to Control Bleeding from Placenta Previa or Accreta During Cesarean Section" @default.
• W2087407265 doi "https://doi.org/10.1097/01.ogx.0000197832.63634.fe" @default.
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