Transverse Purse String Suture for Placenta Previa in the Presence of Previous Cesarean Section, Experience in Northern Borders Saudi Arabia

Abstract

Objective: To evaluate the effectiveness of lower uterine segment transverse purse string suture in patients with placenta previa and previous cesarean section to preserve uterus.
Study Design: We conducted a descriptive cross-sectional study.
Place and Duration of Study: Maternal and Children Hospital, Arar in Northern Borders Saudi Arabia from 2016 to 2020.
Materials and Methods: We included patients with previous cesarean section and complete placenta previa where we had applied transverse purse string suture in the lower uterine segment to control hemorrhage after the failure of preliminary measures of uterotonics' usage and figure of eight sutures at the site of placental bed.
Results: Lower uterine segment purse string suture was applied in 40 patients during cesarean section after failure of preliminary measures, among them 13 patients were found to have placenta accreta spectrum including one with placenta percreta. In 37(92.5%) patients including all patients with placenta accreta spectrum except one patient with placenta percreta, hemorrhage was successfully secured, and the uterus was preserved. In three patients (7.5%) including one patient with placenta percreta, lower uterine segment
transverse purse string suture failed to control hemorrhage and hysterectomy was performed.
Conclusion: Lower uterine segment transverse purse string suture is an effective intervention in controlling hemorrhage to preserve uterus in patients with placenta previa and previous cesarean section.