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Enclosing sutures technique for control of local bleeding in a case of placenta increta
Jun Takeda1, Shintaro Makino1, Yuko Matsumura1
1Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.
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.
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.
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