The “Nested Suture” Technique for Achieving Hemostasis After Cold-Knife Conization of the Cervix During Pregnancy

Abstract

Background: Cold-knife cervical conization performed during pregnancy is technically challenging and may be accompanied by a greater risk of severe hemorrhage than conization performed in a nonpregnant patient. A handful of techniques for cervical conization during pregnancy have been described in the literature, but no direct comparative data exist. Case: A surgical approach (called the “nested suture” technique) for achieving hemostasis during cold-knife conization of the cervix is described. The technique involves placement of circumferential U-sutures prior to excision of the cone biopsy specimen; the sutures are placed immediately cephalad to the apex of the planned biopsy and are tied down prior to excising the specimen. Use of this technique in a woman at 13 weeks' gestation resulted in minimal blood loss with no immediate or delayed postoperative complications; the patient underwent successful cesarean delivery at term. Conclusions: The “nested suture” technique offers another surgical approach for securing hemostasis at the specimen excision site in women who require cold-knife conization during pregnancy. (J GYNECOL SURG 27:193)