Abstract
Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: This was a non-comparative retrospective study of 188 patients diagnosed with pernicious placenta previa who underwent cesarean section in The First Hospital of Jilin University, China, from 1 January 2013 to 1 January 2018. Successful group was defined as those in which the intraoperative bleeding was managed by either modified CHO or by B-lynch suture technique and those who had further intervention including hysterectomy were designated as failure group. Results: Out of 217 patients, 188 met inclusion criteria and 29 patients were excluded. In 188 cases, 183 (97.34%) cases successes and 5 (2.65%) cases had hysterectomy. Among included group, 118 patients (62.76%) had undergone emergency cesarean section and 70 patients (37.23%) underwent elective cesarean section. The emergency group had significantly lesser gestation period of gestation at the time of cesarean section (P = 0.021) and lower neonatal weight (P = 0.001) than that of elective group. The estimated blood loss during surgery was 500 - 3200 ml (mean: 925 ml). Additionally, the amount of bleeding was found to be significantly more in patient with intraoperative complication (P = 0.007) and in patient with implanted placenta (P 0.001). Conclusion: The conservative compression suture technique including modified CHO and B-lynch suture technique during the cesarean delivery is a feasible, safe and effective alternative conservative surgical technique for the management of bleeding in case of pernicious placenta previa. Besides good surgical outcome and proper neonatal result this technique also reduces the rate of hysterectomy, thus conserving the fertility.
Highlights
In recent times, the frequency of cesarean section (CS) delivery has increased to unprecedented stages, resulting in growing obstetrical sequelae [1]
To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies
In addition to short-term risks, CS delivery can lead to complications in successive pregnancies, including cesarean scar pregnancy with life-threatening haemorrhage, placenta accrete, placenta previa, abnormal uterine bleeding following surgery, uterine rupture and diminished subsequent fertility [2] [3]
Summary
The frequency of cesarean section (CS) delivery has increased to unprecedented stages, resulting in growing obstetrical sequelae [1]. Several adjuvant hemostatic techniques including, internal iliac artery ligation, interventional arterial radioembolization, balloon occlusion of the artery are used to minimize intraoperative blood loss and in very severe circumstances hysterectomy is done [6] [7] [8]. Though, all of these above techniques have their own limitation and conservation of fertility in consequent pregnancies is an important issue. The objective of the present study was to investigate the efficiency of various surgical suture techniques used in our hospital in the management of PPP to conserve fertility in the subsequent pregnancy
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