Placenta Accreta Spectrum Disorders: A. Chohan Continuous Squeezing Suture (ACCSS) for Controlling Haemorrhage from the Lower Uterine Segment at Caesarean Section

Muhammad Arshad Chohan; Prof Fauzia  Butt; Dr Maria  Imran; Dr Sadaf Zahra; Dr Moiz Chohan

doi:10.12669/pjms.39.1.6990

Muhammad Arshad Chohan King Edward Medical University
Prof Fauzia Butt Department of Obstetrics & Gynaecology, Sharif Medical & Dental College / Sharif Medical City Hospital, Lahore, Pakistan
Dr Maria Imran Department of Obstetrics & Gynaecology, Lady Willingdon Hospital / King Edward Medical University, Lahore, Pakistan
Dr Sadaf Zahra Department of Obstetrics & Gynaecology, Lady Willingdon Hospital / King Edward Medical University, Lahore, Pakistan
Dr Moiz Chohan 5. Department of Obstetrics & Gynaecology, Ghurki Trust Teaching Hospital, Lahore, Pakistan

DOI: https://doi.org/10.12669/pjms.39.1.6990

Keywords: Accreta spectrum disorders, Postpartum haemorrhage, Peripartum hysterectomy, Placenta praevia

Abstract

Objectives: To describe the simplicity, efficacy and safety of A. Chohan Continuous Squeezing Suture (ACCSS) for controlling haemorrhage from the lower uterine segment at caesarean section for placenta praevia and accreta spectrum disorders.

Methods: This prospective study was conducted on 47 patients with placenta praevia and accreta spectrum disorders from February 2019 to May 2022 in two teaching hospitals of Lahore and ACCSS was applied. The outcome measures were peripartum hysterectomy procedure time, estimated blood loss, number of blood transfusions, duration of stay in the hospital, bladder trauma, uterine necrosis, pelvic abscess formation, secondary postpartum haemorrhage and maternal mortality. Descriptive statistics were calculated by using SPSS version 21.

Results: Out of 47 patients, 7 (15%) had placenta creta, 29 (61.7%) increta, 11 (23.3%) percreta (grade 3a), and 36 (76.6%) central anterior dominant placenta. Peripartum hysterectomy was prevented in 97.8% of patients. ACCSS procedure time was 5-10 minutes (87.2%), with mean blood loss 2500±485 ml, mean blood transfusion 1.85±1.02 units and mean hospital stay of 3.3±0.84 days. One patient had bladder trauma. There was no case of uterine necrosis, pelvic abscess formation, secondary postpartum haemorrhage or maternal mortality.

Conclusion: ACCSS appears to be a simple, effective and safe treatment option for placenta praevia and accreta spectrum disorders, as an alternative to hysterectomy.

Registration: ClinicalTrial.gov NCT04660578, NCT05070689.

doi: https://doi.org/10.12669/pjms.39.1.6990

How to cite this:
Chohan MA, Butt F, Imran M, Zahra S, Chohan MA. Placenta Accreta Spectrum Disorders: A. Chohan Continuous Squeezing Suture (ACCSS) for Controlling Haemorrhage from the Lower Uterine Segment at Caesarean Section. Pak J Med Sci. 2023;39(1):166-171. doi: https://doi.org/10.12669/pjms.39.1.6990

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.