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216264

Purse string suturing of the lower uterine segment in placenta accreta spectra syndrome for control of bleeding: a prospective case series study

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Last updated: 03 Jan 2025

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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

DOI

10.21608/egyfs.2022.216264

Keywords

Placenta accrete spectra syndrome, Cesarean Hysterectomy, Lower uterine segment, a purse-string suture

Authors

First Name

Maher

Last Name

Elesawi

MiddleName

-

Affiliation

Lecturer of Obstetrics and Gynecology, Faculty of Medicine – Mansoura University

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City

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Orcid

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Volume

26

Article Issue

1

Related Issue

30512

Issue Date

2022-01-01

Receive Date

2022-01-29

Publish Date

2022-01-01

Page Start

38

Page End

43

Print ISSN

1110-6352

Online ISSN

2536-9768

Article File

EGYFS_Volume 26_Issue 1_Pages 38-43.pdf

PDF . 1.6MB

Link

https://egyfs.journals.ekb.eg/article_216264.html

Detail API

https://egyfs.journals.ekb.eg/service?article_code=216264

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4

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Original Article

Type Code

319

Publication Type

Journal

Publication Title

The Egyptian Journal of Fertility of Sterility

Publication Link

https://egyfs.journals.ekb.eg/

MainTitle

Purse string suturing of the lower uterine segment in placenta accreta spectra syndrome for control of bleeding: a prospective case series study

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Article

Created At

22 Jan 2023