Supracervical cerclage with intracavitary balloon to control bleeding associated with placenta previa

Abstract

A supracervical cerclage suturing technique with an intracavitary balloon (SCCB) was developed to simultaneously compress bleeding from the placental bed and the outside uterine wall. Twenty cesarean sections were performed due to placenta previa over three years. The SCCB was used in 13 patients with uncontrolled bleeding after failure of conventional methods. The conventional surgical hemostatic techniques were applied first in patients with copious bleeding due to placenta previa. If bleeding continued, a three-way Foley catheter was inserted into the uterine cavity through the cervix and SCCB was performed. About 50-100 mL of normal saline was infused to inflate the catheter balloon. On the next morning, attempts were made to withdraw the F-catheter but if bleeding started again, another 12 h of pressure was provided. The mean removal time for the intracavitary Foley catheter was 20.6±12.3 h. There was one case of subtotal hysterectomy after the SCCB. All patients were followed for at least 12 months. There were no specific complications related to the procedure. All women returned to their normal menstrual cycles and one had an ongoing third trimester pregnancy. The SCCB is a simple and effective technique to control bleeding associated with placenta previa.