胎盤前置胎盤に対する子宮温存治療の改良法である波状圧迫縫合術による下部子宮 segment の再建

Women with placenta previa (PP) typically present with severe hemorrhaging during cesarean section (CS). Nevertheless, the hemostatic efficacy of the current suture technique remains to be optimized. This study was conducted to evaluate the efficacy of reconstructing the lower uterine segment by wave compression suture (WCS) in women with PP who have underwent CS. The cohort study included 123 women who received WCS as the first uterine suture technique between 2016 and 2020 at the West China Second University Hospital of Sichuan University. The hemostatic effect of WCS was evaluated in accordance with the type of PP and the intraoperative circumstances. A total of 72 (58.5%) women were successfully achieved hemostasis without the need for further intervention. In 51 (41.5%) cases, additional procedures were required, namely uterine artery ligation, cervical hanging maneuver, and Bakri tamponade. Seventy-nine cases exhibiting thin anterior walls and lower uterine atony following placental dissection; of these, 72 (91.1%) achieved hemostasis through WCS. No woman required a subsequent laparotomy or hysterectomy. No complications were identified as being attributable to the WCS following surgery. Among the 5 women who subsequently became pregnant, no intrauterine adhesions or abnormal uterine morphologies were caused by WCS. No ectopic or cesarean scar pregnancies occurred. WCS represents an efficient technique for women presenting with thin anterior walls and uterine atony of the lower uterine segment, in conjunction with PP.