Purse string suturing of the lower uterine segment in placenta accreta spectra syndrome for control of bleeding: a prospective case series study | ||||
| The Egyptian Journal of Fertility of Sterility | ||||
| Article 4, Volume 26, Issue 1 - Serial Number 11106352, January 2022, Page 38-43 PDF (1.52 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/egyfs.2022.216264 | ||||
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| Author | ||||
| Maher Elesawi | ||||
| Lecturer of Obstetrics and Gynecology, Faculty of Medicine – Mansoura University | ||||
| Abstract | ||||
| Background: The placenta accreta spectrum (PAS) is a worldwide health problem due to increasing cesarean section rates. A severe maternal complication can occur due to bleeding and invasion of nearby organs. Although many techniques were described to help in intraoperative management, no standard agreement on the best one, and unfortunately, in many conditions, cesarean hysterectomy can only save the mother's life. There's a must to find out new techniques that could help in preserving the uterus. Objective: This prospective study was taken on 26 patients at Mansoura University Hospital diagnosed with PAS. There were 13 cases PAS grade 1, 7 cases grade 2, 6 cases grade 3A. All the cases were electively delivered at 37 w. Purse string suturing was done to plicate the lower uterine segment and provide natural tamponade to decrease blood loss from the placental bed and preserve the uterus. Results: the success rate of the procedure in preserving the uterus was 96%. The average blood loss was 1557.69 ± 318.96. Massive blood loss (2500 ml) occurred in 1 case, intraoperative after the procedure. The procedure is simple, not time-consuming, and no special skills are required. A large number of patients and long term follow up are needed to ensure the efficacy of the procedure and the state of future fertility. Conclusion: management of patients with PAS should be individualized according to PAS grade and patient wishes. The purse-string suure technique can help in reducing blood loss and decrease the cesarean hysterectomy rate | ||||
| Keywords | ||||
| Placenta accrete spectra syndrome; cesarean hysterectomy; lower uterine segment; a purse-string suture | ||||
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