Objective: To explore the efficacy and safety of uterine lower posterior wall breakwater-like
suture technique in controlling the intraoperative
bleeding of
placenta previa. Methods: From June 2016 to June 2017, 47 patients were diagnosed
placenta previa in Union Hospital, Tongji Medical College of Huazhong University of Science and Technology. Posterior wall breakwater-like
suture technique was used preferentially, as for cases with poor myometrium layer, lower anterior wall stitch
suture was used at the same time. Bilateral descending branches of uterine artery
ligation and Cook balloon compression of uterine lower segment was conducted when necessary. The clinic data of the 47 cases were analyzed. Results: Thirty cases (63.8, 30/47) were diagnosed placenta inccreta or percreta by ultrasound or MRI preoperatively. Senventeen cases were diagnosed as
placenta accreta (36.2%, 17/47) . Thirty-four cases had the previous history of
cesarean section. The average cervical canal length of 47 patients was (2.8±0.9) cm. There were 19 cases (40.4%,19/47) with 1 time posterior wall breakwater-like sutured and 16 cases (34.0%,16/47) with 2 or 3 times posterior wall breakwater-like sutured; 12 cases (25.5%,12/47) were treated with anterior wall stitch
suture simultaneously.Ten cases (21.3%, 10/47) underwent uterine artery
ligation, 17 cases (36.2%, 17/47) underwent COOK balloon compression on the staxis surface of lower segment. None of them had
postpartum hemorrhage or performed internal iliac artery embolization. The median blood loss in the operation was 700 ml, the percentiles 25 was 500 ml, and the percentiles 75 was 1 200 ml. The blood loss ≥1 000 ml in 18 (38.3%, 18/47) patients,and the most serious one was 2 500 ml. The median
blood transfusion volume (including allogenetic transfusion and
autotransfusion) was 450 ml, the percentiles 25 was 228 ml, and the percentiles 75 was 675 ml. The average
vaginal bleeding volume was (150±63) ml first day after operation. The mean hospitalization time was (4.7±1.0) days. The mean gestational weeks of pregnancy termination was (36.1±1.5) weeks, and the mean
birth weight of newborns was (2 817±492) g. Apgar score:1-minute 7.8±1.1, 5-minute 8.9±0.8. No
neonatal death, 16 cases were transferred to neonatal ICU (34.0%, 16/47) mainly for premature delivery and low birth weight. No complication was found in 6 months post-operation. Conclusions: Uterine posterior wall breakwater-like
suture technique is a simple, safe and effective way in controlling intraoperative
bleeding of placental previa.Lower anterior wall stitch
suture could effectively stop
bleeding and restore the normal uterine shape. Combined application of various methods could significantly reduce the incidence of
postpartum hemorrhage and
hysterectomy, and improve maternal and fetal prognosis.