Huang Changxiao, Peng Zhuyun, Li Lanfang, Gao Xiang, Xiao Han, Wang Wan, Zhang Li, Yang Yujiao, Gu Xing, Zheng Xiuhui
Department of Gynecology and Obstetrics, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing, 400042, P.R. China.
BMC Pregnancy Childbirth. 2025 Apr 2;25(1):381. doi: 10.1186/s12884-025-07469-4.
To explore the effectiveness and feasibility of double-row transfixion suture of the lower uterine segment in cesarean section (CS) in patients with pernicious placenta previa complicated by placenta accrete spectrum disorder.
This retrospective study included 91 women who received CS for pernicious placenta previa complicated by placenta accrete spectrum, which was suggested by preoperative ultrasound and MRI assessment, and confirmed by operation or postoperative pathology. Preoperative ultrasonographic scores were > 6 in all patients. Of them, 47 patients received double-row transfixion suture of the lower uterine segment (study group), and the remaining 44 patients received abdominal aortic balloon placement combined with other uterine suture techniques (control group). The clinical therapeutic efficacy was compared between the two groups. All patients were followed up for two years, during which the duration of bloody lochia, uterine status, menstrual cycle and re-pregnancy were observed.
The study group showed obvious advantages in operative time, length of hospital stay, intraoperative blood loss, and hospitalization cost (P < 0.05). Uterine resection was performed in two cases in the control group vs. none in the study group. During the two-year follow-up period, no significant difference was observed in the duration of lochia in patients with the uterus preserved between the two groups. The uterus was restored to the normal size within 42 days post-operation, and there was no significant difference in menstrual cycle 2 years post-operation. Uterine diverticulum occurred in 3 cases in the control group and 4 in the study group. Except for one patient who underwent artificial abortion because of contraceptive failure, all other patients have had no intention of getting pregnant again.
Double-row transfixion suture of the lower uterine segment in CS for pernicious placenta previa complicated by placenta accrete spectrum deserves wider clinical application, especially in basic-level hospitals, due to reliable hemostasis, shorter operative time, quicker postoperative recovery, fewer complications, lower hospitalization cost, and avoidance of uterine resection.
探讨剖宫产术中子宫下段双排贯穿缝扎术用于凶险性前置胎盘合并胎盘植入谱系疾病患者的有效性及可行性。
本回顾性研究纳入91例因凶险性前置胎盘合并胎盘植入谱系疾病行剖宫产术的女性患者，术前超声及磁共振成像（MRI）评估提示该病，并经手术或术后病理确诊。所有患者术前超声评分均>6分。其中，47例患者行子宫下段双排贯穿缝扎术（研究组），其余44例患者行腹主动脉球囊置入联合其他子宫缝扎技术（对照组）。比较两组的临床治疗效果。对所有患者进行两年随访，观察血性恶露持续时间、子宫情况、月经周期及再次妊娠情况。
研究组在手术时间、住院时间、术中出血量及住院费用方面显示出明显优势（P<0.05）。对照组有2例行子宫切除术，研究组无。在两年随访期内，两组保留子宫患者的恶露持续时间无显著差异。术后42天内子宫恢复至正常大小，术后两年月经周期无显著差异。对照组有3例发生子宫憩室，研究组有4例。除1例因避孕失败行人工流产外，其他患者均无再次妊娠意愿。
剖宫产术中子宫下段双排贯穿缝扎术用于凶险性前置胎盘合并胎盘植入谱系疾病，止血可靠，手术时间短，术后恢复快，并发症少，住院费用低，且可避免子宫切除，值得在临床更广泛应用，尤其在基层医院。
