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'Nausicaa' compression suture: a simple and effective alternative to hysterectomy in placenta accreta spectrum and other causes of severe postpartum haemorrhage.

ABSTRACT: Postpartum haemorrhage (PPH), especially resulting from placenta accreta spectrum (PAS), has become a worldwide concern in maternity care. We describe a novel method of uterine compression sutures (the 'Nausicaa' technique) as an alternative to hysterectomy for patients who have suffered from major PPH. We applied this technique in 68 patients with major PPH during caesarean section (including 43 patients with PAS, 20 patients with placenta praevia totalis, and five patients with uterine atony), and none of these patients required further hysterectomy. We conclude that our Nausicaa suture is a simple and feasible alternative to hysterectomy in patients suffering from major PPH.

SUBMITTER: Shih JC

PROVIDER: S-EPMC6585672 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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'Nausicaa' compression suture: a simple and effective alternative to hysterectomy in placenta accreta spectrum and other causes of severe postpartum haemorrhage.

Shih J-C JC Liu K-L KL Kang J J Yang J-H JH Lin M-W MW Yu C-U CU

BJOG : an international journal of obstetrics and gynaecology 20180820 3

Postpartum haemorrhage (PPH), especially resulting from placenta accreta spectrum (PAS), has become a worldwide concern in maternity care. We describe a novel method of uterine compression sutures (the 'Nausicaa' technique) as an alternative to hysterectomy for patients who have suffered from major PPH. We applied this technique in 68 patients with major PPH during caesarean section (including 43 patients with PAS, 20 patients with placenta praevia totalis, and five patients with uterine atony), ...[more]

PMID: 30009547

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Project description:Placenta previa and placenta accreta carry significant maternal and fetal morbidity and mortality. Several techniques have been described in the literature for controlling massive bleeding associated with placenta previa cesarean sections. The objective of this study was to evaluate the efficacy and safety of the use of the cervix as a natural tamponade in controlling postpartum hemorrhage caused by placenta previa and placenta previa accreta.This prospective study was conducted on 40 pregnant women admitted to our hospital between June 2012 and November 2014. All participating women had one or more previous cesarean deliveries and were diagnosed with placenta previa and/or placenta previa accreta. Significant bleeding from the placental bed during cesarean section was managed by inverting the cervix into the uterine cavity and suturing the anterior and/or the posterior cervical lips into the anterior and/or posterior walls of the lower uterine segment.The technique of cervical inversion described above was successful in stopping the bleeding in 38 out of 40 patients; yielding a success rate of 95%. We resorted to hysterectomy in only two cases (5%). The mean intra-operative blood loss was 1572.5 mL, and the mean number of blood units transfused was 3.1. The mean time needed to perform the technique was 5.4?±?0.6 min. The complications encountered were as follows: bladder injury in the two patients who underwent hysterectomy and wound infection in one patient. Postoperative fever that responded to antibiotics occurred in 1 patient. The mean duration of the postoperative hospital stay was 3.5 daysThis technique of using the cervix as a natural tamponade appears to be safe, simple, time-saving and potentially effective method for controlling the severe postpartum hemorrhage (PPH) caused by placenta previa/placenta previa accreta. This technique deserves to be one of the tools in the hands of obstetricians who face the life-threatening hemorrhage of placenta accreta.ClinicalTrials.gov NCT02590484 . Registered 28 October 2015.

Project description:BackgroundIdentification of pregnancies with postpartum haemorrhage (PPH) antenatally rather than intrapartum would aid delivery planning, facilitate transfusion requirements and decrease maternal complications. MRI has been increasingly used for placenta evaluation. Here, we aim to build a nomogram incorporating both clinical and radiomic features of placenta to predict the risk for PPH in pregnancies during caesarian delivery (CD).MethodsA total of 298 pregnant women were retrospectively enrolled from Henan Provincial People's Hospital (training cohort: n = 207) and from The Third Affiliated Hospital of Zhengzhou University (external validation cohort: n = 91). These women were suspected with placenta accreta spectrum (PAS) disorders and underwent MRI for placenta evaluation. All of them underwent CD and were singleton. PPH was defined as more than 1000 mL estimated blood loss (EBL) during CD. Radiomic features were selected based on their correlations with EBL. Radiomic, clinical, radiological, clinicoradiological and clinicoradiomic models were built to predict the risk of PPH for each patient. The model with the best prediction performance was validated with its discrimination ability, calibration curve and clinical application.FindingsThirty-five radiomic features showed strong correlation with EBL. The clinicoradiomic model resulted in the best discrimination ability for risk prediction of PPH, with AUC of 0.888 (95% CI, 0.844-0.933) and 0.832 (95% CI, 0.746-0.913), sensitivity of 91.2% (95% CI, 85.8%-96.7%) and 97.6% (95% CI, 92.7%-100%) in the training and validation cohort respectively. For patients with severe PPH (EBL more than 2000 mL), 53 out of 55 pregnancies (96.4%) in the training cohort and 18 out of 18 (100%) pregnancies in the validation cohort were identified by the clinicoradiomic model. The model performed better in patients without placenta previa (PP) than in patients with PP, with AUC of 0.983 compared with 0.867, sensitivity of 100% compared with 90.8% in the training cohort, AUC of 0.832 compared with 0.815, sensitivity of 97.6% compared with 97.2% in the validation cohort.InterpretationThe clinicoradiomic model incorporating both prenatal clinical factors and radiomic signature of placenta on T2WI showed good performance for risk prediction of PPH. The predictive model can identify severe PPH with high sensitivity and can be applied in patients with and without PP.

Dataset Information

'Nausicaa' compression suture: a simple and effective alternative to hysterectomy in placenta accreta spectrum and other causes of severe postpartum haemorrhage.

Publications

'Nausicaa' compression suture: a simple and effective alternative to hysterectomy in placenta accreta spectrum and other causes of severe postpartum haemorrhage.

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