Prophylactic Ghosh Uterine Compression Suture Technique to Prevent Severe Postpartum Hemorrhage in Placenta Accreta

Placenta accreta is associated with severe postpartum hemorrhage (PPH) and may require massive transfusion and emergency hysterectomy, contributing to substantial maternal morbidity and mortality. The prophylactic use of the Ghosh uterine compression suture (Alternate Sequential Suture Tightening Technique (ASSTT)) may reduce hemorrhagic complications. This report describes two patients (one primigravida and one gravida 2) with antenatally diagnosed placenta accreta based on ultrasound and magnetic resonance imaging (MRI), without other comorbidities, who underwent elective-term cesarean delivery with prophylactic ASSTT and circumferential cervical suturing. The mean time to place the Ghosh suture was four to five minutes, and the mean estimated blood loss was 450 mL (range: 450-500 mL). Neither patient required a transfusion, and both were discharged on postoperative day 3 without complications. After lactation, both resumed regular menses and subsequently achieved uncomplicated pregnancies. The first patient conceived spontaneously three years later and underwent an uncomplicated term repeat cesarean delivery. The second patient conceived via in vitro fertilization (IVF) for sex selection 3.5 years later; antenatal imaging was unremarkable. However, a morbidly adherent placenta was identified intraoperatively, and ASSTT with circumferential cervical suturing was repeated. The patient was discharged on postoperative day 3 without complications. These cases suggest that prophylactic ASSTT, combined with circumferential cervical suturing, may be a feasible uterus-sparing strategy in selected patients with placenta accreta.