A novel hemostatic suture technique for uterine rupture complicated by placenta accreta spectrum: A case report

Uterine rupture secondary to the placenta accreta spectrum (PAS) is a life-threatening obstetric emergency. Intractable massive hemorrhage in this setting often necessitates emergent hysterectomy, while effective fertility-sparing surgical options for such critical bleeding remain limited. This report highlights the utility of a novel suturing technique for achieving effective hemostasis and fertility preservation in patients with PAS-related uterine rupture.

A 36-year-old Asian woman diagnosed with PAS presented with spontaneous uterine rupture at 16+ weeks of gestation, complicated by severe refractory intra-abdominal hemorrhage.

The diagnosis of PAS-related uterine rupture was confirmed based on the patient's previous cesarean delivery history, clinical manifestations, preoperative imaging findings, and postoperative pathological results.

A novel technique combining anteroposterior traction and bilateral reinforcement sutures of the lower uterine segment was applied for hemostasis, with an estimated intraoperative blood loss of 400 mL.

The patient recovered uneventfully and was discharged on postoperative day (POD) 11; regular menses persisted at 1-year follow-up.

PAS-related uterine rupture is easily misdiagnosed or delayed owing to variable clinical presentations. Conventional hemostatic approaches are often ineffective for refractory severe hemorrhage. This novel combined suturing technique offers a simple, feasible fertility-sparing strategy to avoid unnecessary hysterectomy and improve maternal outcomes in catastrophic obstetric bleeding.