A prospective evaluation and management of different types of placenta praevia using parallel vertical compression suture to preserve uterus

The rising tendency of cesarean sections will lead invariably to more complications such as placenta praevia. The aim of our study was to evaluate the utility of parallel vertical compression suture to preserve uterus in cases of placenta praevia, and to propose a rational approach of these problematic cases, according to their grade of myometrial invasion. We prospectively included 95 consecutive cases diagnosed with placenta praevia (group1 [Gr1]) where we used parallel compression suture and compared to retrospectively analyzed 100 consecutive cases managed without using this technique (group 2 [Gr2]). We differentiated the types of placenta praevia according to their invasion in myometrium because this parameter appreciates best their degree of severity, so we had 4 Grs: simple praevia (no adherent), accreta, increta, and percreta. All patients underwent ultrasound evaluation before surgery. Cesarean section was planned at 35 to 36 weeks. The main goal was to preserve the uterus whenever was possible. After opening the peritoneal cavity, we first inspected the lower segment and bladder. If no signs of engorged and tortuous vessels we dissected first the bladder and then performed a transverse hysterotomy, removed the placenta and placed 2 parallel vertical sutures on the lower segment below the hysterotomy incision through the entire thickness of both uterine walls. In cases of massively engorged vessels we dissected the bladder after infant delivery and made a transvers...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Quality Improvement Study Source Type: research