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Original Article
Department of Obstetrics and Gynecology, China Meitan General Hospital, No. 29, Xibahe Nanli, Chaoyang District, Beijing, China
Department of Radiation Oncology, Peking University School of Oncology, Peking University Cancer Hospital, Haidian District, Beijing, China
c
Department of Obstetrics and Gynecology, Beijing Fengtai Hospital Afliated to Capital Medical University, Beijing, China
b
a r t i c l e i n f o
a b s t r a c t
Article history:
Accepted 12 October 2015
Objective: To assess the efcacy and safety of longitudinal parallel compression suture to control heavy
postpartum hemorrhage (PPH) in patients with placenta previa/accreta.
Materials and Methods: Fifteen women received a longitudinal parallel compression suture to stop lifethreatening PPH due to placenta previa with or without accreta during cesarean section. The suture
apposed the anterior and posterior walls of the lower uterine segment together using an absorbable
thread A 70-mm round needle with a Number-1 absorbable thread was used. The point of needle entry
was 1 cm above the upper margin of the cervix and 1 cm from the right lateral border of the lower
segment of the anterior wall. The suture was threaded through the uterine cavity to the serosa of the
posterior wall. Then, it was directed upward and threaded from the posterior to the anterior wall at ~1
e2 cm above the upper boundary of the lower uterine segment and 3-cm medial to the right margin of
the uterus. Both ends of the suture were tied on the anterior aspect of uterus. The left side was sutured in
the same way.
Results: The success rate of the procedure was 86.7% (13/15). Two of 15 cases were concurrently
administered gauze packing and achieved satisfactory hemostasis. All patients resumed a normal
menstrual ow, and no postoperative anatomical or physiological abnormalities related to the suture
were observed. Three women achieved further pregnancies after the procedure.
Conclusion: Longitudinal parallel compression suture is a safe, easy, effective, practical, and conservative
surgical technique to stop intractable PPH from the lower uterine segment, particularly in women who
have a cesarean scar and placenta previa/accreta.
Copyright 2016, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. This
is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/
4.0/).
Keywords:
longitudinal parallel compression suture
lower uterine segment
placenta previa accreta
postpartum hemorrhage
Introduction
Postpartum hemorrhage (PPH) is a leading cause of maternal
mortality worldwide and is responsible for approximately 25% of all
maternal deaths [1]. It is estimated that more than 127,000 women
worldwide die annually from obstetric hemorrhage [2]; however,
90% of maternal deaths due to PPH are preventable [3].
Placental abnormalities are a major contributor to obstetric
hemorrhage. The most common placental abnormalities are
placental abruption, placenta previa, and an adherent (accreta,
http://dx.doi.org/10.1016/j.tjog.2016.02.008
1028-4559/Copyright 2016, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
194
195
Table 1
Characteristics of patients with severe postpartum hemorrhage treated with longitudinal parallel compression suture.
Case Age Gravidity Term
Presenting
no. (y) & parity (wk of gestation) diagnosis
23
G1P0
37 1
Placental previa
2500
29
G2P0
36 3
Placental previa
2400
38
G3P1
37 1
3600
25
G1P0
37 1
2000
23
G2P0
37 1
Placental previa
accreta
Placental previa
42
G4P1
36 6
3200
32
G3P1
36 5
Placental previa
2800
31
G3P0
36 2
Placental previa
2500
36
G4P1
37 2
2800
10
11
26
23
G2P1
G1P0
37
36 6
Placental previa
accreta
Placental previa
Placental previa
12
32
G2P0
38 1
13
27
G2P0
36 4
14
24
G2P0
36 6
15
35
G2P1
37 3
Placental previa
accreta
Placental previa
Placental previa
accreta
Placental previa Uterine
accreta
atony
2500
2000
2500
2200
2000
2400
3400
5 units PRBC
200 mL FFP
5 units PRBC
400 mL FFP
10units PRBC
800 mL FFP
2 units platelets
4 units PRBC
200 mL FFP
6 units PRBC
400 mL FFP
9 units PRBC
600 mL FFP
1 units platelets
6 units PRBC
400 mL FFP
6 units PRBC
200 mL FFP
7 units PRBC
400 mL FFP
3 units PRBC
5 units PRBC
300 mL FFP
4 units PRBC
400 mL FFP
3 units PRBC
200 mL FFP
5 units PRBC
400 mL FFP
9 units PRBC
600 mL FFP
Follow-up
Operation time/new Adjunctive Resumed
suture time (min)
hemostatic menstruation/achieved (mo)
procedures gestation
(mo)
80/8
4/30
68
65/8
50
42
100/10
102
90/9
2/39
63
46
65/7
54
60/8
37
80/7
25
60/6
55/6
4
2
88
66
70/6
46
70/7
38
80/7
4/28
90/9
145/13
95/10
Gauze
packing
Gauze
packing
102
76
196
197