Modified Nausicaa compression suture for lower-segment bleeding in placenta previa and low-lying placenta: A...

Uterine compression sutures are widely used for postpartum hemorrhage, but conventional techniques might be less effective for bleeding from the lower uterine segment in placenta previa. The Nausicaa suture has shown efficacy; however, concerns regarding uterine ischemia remain. We describe a modified Nausicaa compression suture (MNCS) designed to minimize ischemic risk.

This single-center, retrospective observational study included women with singleton pregnancies complicated by placenta previa or low-lying placenta who underwent cesarean delivery between 2018 and 2024. MNCS is a localized uterine compression suture in which U-shaped sutures are placed directly above and below the bleeding point of the lower uterine segment from the serosal side of the anterior or posterior uterine wall, without compressing both walls or penetrating the endometrial cavity. MNCS was applied in cases of persistent bleeding at the placental attachment site.

MNCS technique was applied in 45 women during cesarean section; 11 required additional hemostatic procedures. Among the 34 women managed with MNCS alone, the median blood loss was 728 g (range, 250-2600 g), and the median skin-to-skin operative time was 39 min (range, 26-104 min). No short-term postoperative complications were observed, and eight women subsequently achieved pregnancy.

Despite the limitations of a retrospective, single-center design without a control group and possible selection bias, MNCS appears to be a simple and safe initial hemostatic option for bleeding from the lower uterine segment in placenta previa.