Application of double-row transfixion suture of the lower uterine segment in cesarean section for pernicious placenta previa complicated by placenta accreta spectrum: a comparative clinical study

Abstract

Objective

To explore the effectiveness and feasibility of double-row transfixion suture of the lower uterine segment in cesarean section (CS) in patients with pernicious placenta previa complicated by placenta accrete spectrum disorder.

Methods

This retrospective study included 91 women who received CS for pernicious placenta previa complicated by placenta accrete spectrum, which was suggested by preoperative ultrasound and MRI assessment, and confirmed by operation or postoperative pathology. Preoperative ultrasonographic scores were > 6 in all patients. Of them, 47 patients received double-row transfixion suture of the lower uterine segment (study group), and the remaining 44 patients received abdominal aortic balloon placement combined with other uterine suture techniques (control group). The clinical therapeutic efficacy was compared between the two groups. All patients were followed up for two years, during which the duration of bloody lochia, uterine status, menstrual cycle and re-pregnancy were observed.

Results

The study group showed obvious advantages in operative time, length of hospital stay, intraoperative blood loss, and hospitalization cost (P < 0.05). Uterine resection was performed in two cases in the control group vs. none in the study group. During the two-year follow-up period, no significant difference was observed in the duration of lochia in patients with the uterus preserved between the two groups. The uterus was restored to the normal size within 42 days post-operation, and there was no significant difference in menstrual cycle 2 years post-operation. Uterine diverticulum occurred in 3 cases in the control group and 4 in the study group. Except for one patient who underwent artificial abortion because of contraceptive failure, all other patients have had no intention of getting pregnant again.

Conclusion

Double-row transfixion suture of the lower uterine segment in CS for pernicious placenta previa complicated by placenta accrete spectrum deserves wider clinical application, especially in basic-level hospitals, due to reliable hemostasis, shorter operative time, quicker postoperative recovery, fewer complications, lower hospitalization cost, and avoidance of uterine resection.