Medicine · 2026
A novel hemostatic suture technique for uterine rupture complicated by placenta accreta spectrum: A case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Shang Ruiyan, Yang Jing, Li Li, Zhuge Yiyi
Аннотация
RATIONALE: Uterine rupture secondary to the placenta accreta spectrum (PAS) is a life-threatening obstetric emergency. Intractable massive hemorrhage in this setting often necessitates emergent hysterectomy, while effective fertility-sparing surgical options for such critical bleeding remain limited. This report highlights the utility of a novel suturing technique for achieving effective hemostasis and fertility preservation in patients with PAS-related uterine rupture.
PATIENT CONCERNS: A 36-year-old Asian woman diagnosed with PAS presented with spontaneous uterine rupture at 16+ weeks of gestation, complicated by severe refractory intra-abdominal hemorrhage.
DIAGNOSES: The diagnosis of PAS-related uterine rupture was confirmed based on the patient's previous cesarean delivery history, clinical manifestations, preoperative imaging findings, and postoperative pathological results.
INTERVENTIONS: A novel technique combining anteroposterior traction and bilateral reinforcement sutures of the lower uterine segment was applied for hemostasis, with an estimated intraoperative blood loss of 400 mL.
OUTCOMES: The patient recovered uneventfully and was discharged on postoperative day (POD) 11; regular menses persisted at 1-year follow-up.
LESSONS: PAS-related uterine rupture is easily misdiagnosed or delayed owing to variable clinical presentations. Conventional hemostatic approaches are often ineffective for refractory severe hemorrhage. This novel combined suturing technique offers a simple, feasible fertility-sparing strategy to avoid unnecessary hysterectomy and improve maternal outcomes in catastrophic obstetric bleeding.
PATIENT CONCERNS: A 36-year-old Asian woman diagnosed with PAS presented with spontaneous uterine rupture at 16+ weeks of gestation, complicated by severe refractory intra-abdominal hemorrhage.
DIAGNOSES: The diagnosis of PAS-related uterine rupture was confirmed based on the patient's previous cesarean delivery history, clinical manifestations, preoperative imaging findings, and postoperative pathological results.
INTERVENTIONS: A novel technique combining anteroposterior traction and bilateral reinforcement sutures of the lower uterine segment was applied for hemostasis, with an estimated intraoperative blood loss of 400 mL.
OUTCOMES: The patient recovered uneventfully and was discharged on postoperative day (POD) 11; regular menses persisted at 1-year follow-up.
LESSONS: PAS-related uterine rupture is easily misdiagnosed or delayed owing to variable clinical presentations. Conventional hemostatic approaches are often ineffective for refractory severe hemorrhage. This novel combined suturing technique offers a simple, feasible fertility-sparing strategy to avoid unnecessary hysterectomy and improve maternal outcomes in catastrophic obstetric bleeding.