title: Cervical inversion as a novel technique for postpartum hemorrhage management during cesarean delivery for placenta previa accreta/increta.
abstract: OBJECTIVE
  To describe the use of cervical inversion for postpartum hemorrhage (PPH) management during cesarean delivery for placenta previa accreta/increta.
  
  
  METHODS
  In a retrospective, descriptive study, data were reviewed for cases in which cervical inversion was used to manage PPH during cesarean delivery at a center in Zahedan, Iran, between July 2, 2011, and September 25, 2014. Cervical inversion was applied when placental bleeding was persistent and the sites could not be clearly located. The cervix is inverted using ring forceps or straight Allis forceps, after which the placental bed is sutured to control bleeding. After bleeding is controlled, the cervix is returned to its original position.
  
  
  RESULTS
  Cervical inversion was successfully applied to 10 cases. Mean time to completion of cervical inversion was 4.1 ± 0.7 minutes. In all 10 cases, the bleeding was stopped within 3-5 minutes from the beginning of the cervical inversion procedure. No apparent complications were reported, and blood transfusions or obstetric hysterectomies were not necessary.
  
  
  CONCLUSIONS
  Cervical inversion is a simple, cost-effective, and time-saving procedure for PPH management in placenta previa accreta/increta. It could become a routine procedure for preserving the uterus and fertility of affected women.
authors.affiliation: Pregnancy Health Research Center and Department of Gynecology and Obstetrics, School of Medicine, Zahedan University of Medical Sciences and Health Services, Zahedan, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Sakhavar
authors.affiliation: Genetics of Non-communicable Disease Research Center and Department of Histology, School of Medicine, Zahedan University of Medical Sciences and Health Services, Zahedan, Iran. Electronic address: histology@ymail.com.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Heidari
authors.affiliation: Genetics of Non-communicable Disease Research Center and Department of Histology, School of Medicine, Zahedan University of Medical Sciences and Health Services, Zahedan, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Mahmoudzadeh-Sagheb
mesh_terms: D002584:Cervix Uteri; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D007492:Iran; D009772:Obstetrical Forceps; D010921:Placenta Accreta / Q000473:pathology; D010923:Placenta Previa / Q000473:pathology; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors
keywords: Cervical inversion; Cesarean delivery; Placenta accreta; Placenta increta; Placenta previa; Postpartum hemorrhage