ElNoury–Webster bundle: a preemptive surgical approach with a modified lower B-Lynch compression suture to manage morbidly low or adherent placenta

Abstract

Objective

To report the technique and outcomes of a surgical care bundle, which preemptively and prophylactically reduces intrapartum bleeding during cesarean sections for these conditions and hence reducing the risk for a cesarean hysterectomy.

Methods

In this report, we present the surgical and clinical outcomes of a case series of 16 patients presenting with a morbidly low or adherent placenta on whom this technique was piloted.

Results

Seven of the sixteen patients (44%) required a blood transfusion ranging from 1 to 5 units of packed RBCs. None of the neonates required neonatal unit admissions. One woman had a subsequent pregnancy, with normal placentation and an uncomplicated delivery by cesarean section. None of the patients in our series had a hysterectomy, needed to return to theater after the initial surgery or had secondary postpartum hemorrhage.

Conclusions

The ElNoury–Webster Bundle is a stepwise surgical technique for the conservative management of morbidly low or adherent placenta particularly in low and middle-income healthcare settings.

Keywords:

• Placenta accreta spectrum
• placenta praevia
• postpartum hemorrhage
• uterine compression suture
• uterine preservation

Ethical approval

The technique was discussed and approved by the relevant scientific committee in each of the participating units (supplementary information). All the women included in this series provided a written informed consent after they were informed of the potential benefits and risks of the technique. Finally, consent was acquired for the use of the video and the patient has reviewed and agreed the final edited version (Available to the editors on request).

Acknowledgments

We thank Professor Amal ElSayed Mahfouz Badran (Department of Obstetrics, Tanta University) for the support and Dr Ahmed Sedik (Swiss insurance Hospital) and Mr. Karim Shahawy (Shorouk Hospital) for assisting and for photo documentation. This work was self-supported.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

MAE: Conceiving the idea and designing the surgical technique, was the principal surgeon and manuscript write up.

SNEW: Development of the surgical technique and the bundle, contributed to the illustration of Figure 1 and manuscript write up.

DAA: Assisted in some cases, Manuscript editing, data analysis.

All authors approved the final version of the manuscript.