Rectangular-Shaped Hemostatic Sutures in the Management of Second-Trimester Placenta Accreta Spectrum Disorders at Tu Du Hospital, Vietnam: A Retrospective Descriptive Study

Abstract

Objectives: The study aimed to delineate the surgical outcomes of rectangular-shaped sutures in PAS surgery.Materials and Methods This retrospective study was conducted between January 2018 and December 2022 at Tu Du Hospital in Vietnam. The study reviewed all PAS cases below 22 weeks of gestational age (GA) that underwent cesarean delivery with rectangular-shaped hemostatic sutures. All the pregnancy characteristics, surgical features, and postoperative outcomes were described.

Results: Among thirteen pregnant women with PAS, GA from 13 to 17 weeks of GA occupied 11/13 cases. PAS was classified as accreta ( n = 1), increta ( n = 1), increta-percreta ( n = 2), percreta ( n = 4), and percreta invasive to other organs ( n = 5). The estimated blood loss was 761.54 ± 614.12 (150-2,100 mL). Intraoperative blood loss between 500 and 1,500 mL accounted for 46.15%. The surgical duration time was 180.77 ± 32.07 (130-260 minutes). Postoperative duration time was 5.85 ± 2.08 (4-12 days). During the postpartum course, one case was reported with postpartum hemorrhage, acute renal dysfunction, and postoperative infection, respectively. Out of 13 PAS cases, 12 cases were successfully managed with conservative surgery.

Conclusion: Surgical management of PAS disorders using rectangular-shaped hemostatic sutures could be acceptable. The technical suture is simple, safe, and cost-effective.

Keywords: Vietnam; cesarean delivery; complicated pregnancy; conservative surgery; placenta accreta spectrum; placenta previa; postpartum hemorrhage; second trimester; ultrasound.

Fig. 1

The rectangular-shaped hemostatic suture by illumination image ( A ) and intraoperative photo ( B ).

Fig. 2

The classification of placenta previa depends on the distance between the lower edge of the placenta (white arrow) and the internal cervical os (white star). This classification on ultrasound includes type I, low-lying placenta ( A ), type II, marginal placenta ( B ); type III, incomplete/partial central placenta ( C ); and type IV, complete/central placenta ( D ).

Fig. 3

Ultrasound images show the myometrial thickness, vesicouterine interface (white arrow), railway sign, lacunae, placental budge, and the degree of hypervascularity on color Doppler ultrasound. According to imaging characteristics, the types of placenta accreta spectrum disorders are classified as accreta ( A ), increta ( B ), and percreta ( C ).