Transverse parallel compression suture with endotracheal tube tamponade for management of hemorrhage in complete placenta previa: A retrospective study.

Abstract

Objective: Our study developed the Transverse Parallel Compression Suture (TPCS) with endotracheal tube tamponade, hypothesizing that its transverse compression design would enhance hemostasis, particularly in placenta accreta spectrum (PAS) cases.

Methods: Between January 1, 2022, and December 31, 2024, 346 women with complete placenta previa were enrolled in this study. To minimize selection bias and control for potential con-founders, we performed propensity score matching (PSM) using a 1:1 nearest-neighbor algorithm with a caliper width of 0.02. The matched cohorts (53 TPCS cases vs. 53 uterine packing controls) demonstrated balanced baseline characteristics. Relevant outcomes, such as operative duration, estimated blood loss, transfusion needs, and hospital stays were collected. Additional data included the uterotonics, postoperative pain levels, re-operation rate, and newborn outcomes.

Results: The results showed that the TPCS group had significantly shorter operative time (59.62 ± 27.04 min vs. 73.87 ± 26.28 min, P = 0.007), reduced intraoperative blood loss (792.45 ± 892.46 mL vs. 1220.75 ± 1090.93 mL, P = 0.029). Also, TPCS was associated with shorter hospitalization (6.10 ± 2.06 vs. 7.49 ± 3.29 days, P = 0.003) and markedly lower reoperation rates (3.8% vs. 60.4%, P < 0.001). TPCS was associated with markedly improved pain management, with 96.2% of patients reporting mild pain (Visual Analogue Scale less than 4) versus 18.9% in the packing group (P < 0.001), alongside an 84% relative reduction in analgesic use (11.3% vs. 71.7%, P < 0.001). Besides, Neonatally, TPCS showed lower NICU admissions (34.0% vs. 56.6%, P = 0.031) with comparable Apgar scores and birth weights.

Conclusion: After rigorous PSM adjustment, TPCS demonstrated superior perioperative safety and recovery advantages over uterine packing in placenta previa management, supporting its adoption in clinical practice. Its simplicity and low resource demand highlight potential utility in diverse settings.