B-Lynch suture, intrauterine balloon, and endouterine hemostatic suture for the management of postpartum hemorrhage due to placenta previa accreta.
OBJECTIVE
To report our experience with a new conservative management approach to treat postpartum hemorrhage (PPH) due to placenta previa accreta.


METHODS
A retrospective study of 9 patients with placenta previa accreta who underwent a conservative management protocol. The protocol consists of preventive radiological catheterization of the descending aorta, cesarean delivery, use of Affronti endouterine square hemostatic sutures, and placement of an intrauterine Bakri balloon in conjunction with B-Lynch suture. In the event of failure of the protocol, subsequent management employs ligation and/or reversible embolization of the uterine arteries followed by hysterectomy if unsuccessful.


RESULTS
Conservative management of PPH was successful in all 9 patients evaluated and avoided the need for ligation and/or reversible embolization of the uterine arteries.


CONCLUSIONS
Management of PPH is dictated by several considerations including hemodynamic status and desire to preserve fertility. The initial results of this conservative protocol for treatment of PPH in high-risk patients with placenta previa accreta are encouraging.
Arduini
Maurizio
M
S.C. Ostetricia e Ginecologia, Azienda Ospedaliera S. Maria della Misericordia, Perugia, Italy. maoard@libero.it
Epicoco
Giorgio
G
Clerici
Graziano
G
Bottaccioli
Elvira
E
Arena
Saverio
S
Affronti
Giuseppe
G
D000328:Adult; D002404:Catheterization; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D010921:Placenta Accreta; D010923:Placenta Previa; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D013536:Suture Techniques