Lower segment folding as novel technique to control bleeding in cases of morbidly adherent placenta

Abstract

Aim

To evaluate the effectiveness of lower segment folding in controlling lower segment bleeding and conserving uterus in cases with morbidly adherent placenta.

Methods

This study was conducted on OB/GYN emergency unit of Sohag University hospital. The upper edge of lower segment was sutured to the internal os in continuous purse-string manner using delayed absorbable sutures “N0 2 vicryl (polyglactin 910).” The sutures incude both anterior and lateral aspects of lower uterine segment. Care was taken to maintain patency of endocervix. The folded lower segment was sutured to upper segment as ordinary closure of hysterectomy.

Results

Thirty-two cases were included. The procedure was successful in all studied group to achieve good hemostasis and preservation of uterus. The estimated intraoperative blood loss was (1645 ± 318), there was no need for massive blood transfusion in all cases as number of blood units transfused ranged from 1 to 4 with mean (2.1 ± 0.53). Time required to perform lower segment folding was ranged from 3 to 8 min with mean (4.9 ± 1.1).

Conclusion

Lower segment folding is a good option for saving the uterus in cases of morbidly adherent placenta. The technique is rapid, easy to be performed without a need of special expertise nor special equipment’s.

Keywords:

• Cesarean section
• lower segment
• morbidly adherent placenta
• placenta accreta
• placenta previa

Disclosure statement

No potential conflict of interest was reported by the authors.