The Nausicaä suture in the management of the placenta accreta spectrum

Placenta accreta spectrum is one of the most serious complications of pregnancy. It may result in major hemorrhage, sepsis, pelvic organ injury, and even maternal death. Cesarean hysterectomy without placenta removal is the mainstream treatment. Owing to the need for surgical expertise and the potential for permanent loss of future fertility, expectant management and various uterine preservation surgeries have been advocated. This review introduces the novel Nausicaä (also spelled as Nausicaa) suture technique and discusses its use in different types of placenta accreta spectrum. Nausicaä is a princess in the ancient Greek epic "Odyssey" and the main character of a blockbuster animated movie "Nausicaä of the Valley of the Wind" in Japan. The name Nausicaä suture was inspired by the impressive giant shelled worm in the film, which resembled the hemostatic uterus sutured with this technique. The Nausicaä suture is a kind of uterine compression suture; however, compared with other uterine compression sutures, it offers greater flexibility to target different bleeding areas for suturing and hemostasis. It is only applied in a focal area and does not encompass the uterine cavity. Therefore, it is less likely to cause uterine necrosis or uterine synechiae. The Nausicaä suture should not be used if the patient is hemodynamically unstable or if there is no access to the uterine serosa corresponding to the area of the endometrial cavity with heavy bleeding. In addition, we also present a summary of the current management strategies of placenta accreta spectrum, including extirpative and expectant management, and discuss their benefits and risks. This Nausicaä suture represents a "walk the middle way" method by finding a balance between the extirpative and expectant treatment methods for placenta accreta spectrum and possibly prevents the shortcomings of both.