Download PDF
CC BY 4.0 · AJP Rep 2025; 15(02): e79-e88
DOI: 10.1055/a-2608-0990
Original Article

Rectangular-Shaped Hemostatic Sutures in the Management of Second-Trimester Placenta Accreta Spectrum Disorders at Tu Du Hospital, Vietnam: A Retrospective Descriptive Study

Van Hoang Bui
1   Integrated Planning Room, Tu Du Hospital, Ho Chi Minh City, Vietnam
2   Clinical Research Center (CRC), Tu Du Hospital, Ho Chi Minh City, Vietnam
,
Hien Thi Nguyen
1   Integrated Planning Room, Tu Du Hospital, Ho Chi Minh City, Vietnam
,
Le Quyen Nguyen
1   Integrated Planning Room, Tu Du Hospital, Ho Chi Minh City, Vietnam
2   Clinical Research Center (CRC), Tu Du Hospital, Ho Chi Minh City, Vietnam
,
Phuong Thao Thi Truong
3   Department of Obstetrics and Gynecology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
,
Phuong Thao Nguyen
1   Integrated Planning Room, Tu Du Hospital, Ho Chi Minh City, Vietnam
,
Lam Phuong Thi Hoang
1   Integrated Planning Room, Tu Du Hospital, Ho Chi Minh City, Vietnam
,
Phuc Nhon Nguyen 
2   Clinical Research Center (CRC), Tu Du Hospital, Ho Chi Minh City, Vietnam
4   Department of Pregnancy Pathology, Tu Du Hospital, Ho Chi Minh City, Vietnam
› Author Affiliations
Funding None.
› Further Information
Also available at
  Permissions and Reprints

Abstract

Objectives

The study aimed to delineate the surgical outcomes of rectangular-shaped sutures in PAS surgery.

Materials and Methods This retrospective study was conducted between January 2018 and December 2022 at Tu Du Hospital in Vietnam. The study reviewed all PAS cases below 22 weeks of gestational age (GA) that underwent cesarean delivery with rectangular-shaped hemostatic sutures. All the pregnancy characteristics, surgical features, and postoperative outcomes were described.

Results

Among thirteen pregnant women with PAS, GA from 13 to 17 weeks of GA occupied 11/13 cases. PAS was classified as accreta (n = 1), increta (n = 1), increta-percreta (n = 2), percreta (n = 4), and percreta invasive to other organs (n = 5). The estimated blood loss was 761.54 ± 614.12 (150–2,100 mL). Intraoperative blood loss between 500 and 1,500 mL accounted for 46.15%. The surgical duration time was 180.77 ± 32.07 (130–260 minutes). Postoperative duration time was 5.85 ± 2.08 (4–12 days). During the postpartum course, one case was reported with postpartum hemorrhage, acute renal dysfunction, and postoperative infection, respectively. Out of 13 PAS cases, 12 cases were successfully managed with conservative surgery.

Conclusion

Surgical management of PAS disorders using rectangular-shaped hemostatic sutures could be acceptable. The technical suture is simple, safe, and cost-effective.

Keywords

cesarean delivery - conservative surgery - complicated pregnancy - postpartum hemorrhage - placenta accreta spectrum - placenta previa - second trimester - ultrasound - Vietnam

Guarantor

The guarantors of this study are V.H.B. and P.N.N.


Ethical Approval

This study was accepted by the ethical committee of the institution with approval number CS/TD/23/15. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


Authors' Contributions

V.H.B. was responsible for conceptualization, methodology, investigation, administrative procedures, and supervision. H.N.T., L.Q.N., P.T.T.T., P.T.N., and L.P.H.T. were responsible for data collection, analysis, and administrative procedures. P.N.N. were responsible for methodology, analysis, and contributed to writing, reviewing, editing, and revising the manuscript. All authors read and approved the final manuscript.




Publication History

Received: 02 April 2025

Accepted: 05 May 2025

Accepted Manuscript online:
15 May 2025

Article published online:
10 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Giouleka S, Tsakiridis I, Chanioti ER. et al. Placenta accreta spectrum: a comprehensive review of guidelines. Obstet Gynecol Surv 2024; 79 (06) 366-381
    PubMedSearch in Google Scholar
  • 2 Zhao J, Li Q, Liao E. et al. Incidence, risk factors and maternal outcomes of unsuspected placenta accreta spectrum disorders: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24 (01) 76
    PubMedSearch in Google Scholar
  • 3 Kayem G, Seco A, Vendittelli F. et al. Risk factors for placenta accreta spectrum disorders in women with any prior cesarean and a placenta previa or low lying: a prospective population-based study. Sci Rep 2024; 14 (01) 6564
    PubMedSearch in Google Scholar
  • 4 Nguyen PN, Vuong ADB, Pham XTT. Neonatal outcomes in the surgical management of placenta accreta spectrum disorders: a retrospective single-center observational study from 468 Vietnamese pregnancies beyond 28 weeks of gestation. BMC Pregnancy Childbirth 2024; 24 (01) 228
    PubMedSearch in Google Scholar
  • 5 Ayub TH, Strizek B, Poetzsch B, Kosian P, Gembruch U, Merz WM. Placenta accreta spectrum prophylactic therapy for hyperfibrinolysis with tranexamic acid. J Clin Med 2023; 13 (01) 135
    PubMedSearch in Google Scholar
  • 6 Del Negro V, Aleksa N, Galli C. et al. Ultrasonographic diagnosis of placenta accreta spectrum (PAS) disorder: ideation of an ultrasonographic score and correlation with surgical and neonatal outcomes. Diagnostics (Basel) 2020; 11 (01) 23
    PubMedSearch in Google Scholar
  • 7 Premkumar A, Huysman B, Cheng C, Einerson BD, Moayedi G. Placenta accreta spectrum in the second trimester: a clinical conundrum in procedural abortion care. Am J Obstet Gynecol 2025; 232 (01) 92-101
    PubMedSearch in Google Scholar
  • 8 Coutinho CM, Noel L, Giorgione V, Marçal LCA, Bhide A, Thilaganathan B. Placenta accreta spectrum disorders and cesarean scar pregnancy screening: are we asking the right questions?. Rev Bras Ginecol Obstet 2021; 43 (05) 347-350
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Bhatia A, Palacio M, Wright AM, Yeo GSH. Lower uterine segment scar assessment at 11-14 weeks' gestation to screen for placenta accreta spectrum in women with prior cesarean delivery. Ultrasound Obstet Gynecol 2022; 59 (01) 40-48
    PubMedSearch in Google Scholar
  • 10 Self A, Cavallaro A, Collins SL. Placenta accreta spectrum: imaging and diagnosis. Obstet Gynaecol 2025; 27 (01) 15-28
    PubMedSearch in Google Scholar
  • 11 Alves ÁLL, Silva LBD, Costa FDS, Rezende GC. Management of placenta accreta spectrum. Rev Bras Ginecol Obstet 2021; 43 (09) 713-723
    PubMedSearch in Google Scholar
  • 12 Zhu L, Lu J, Huang W. et al. A modified suture technique for the treatment of patients with pernicious placenta previa and placenta accreta spectrum: a case series. Ann Transl Med 2021; 9 (14) 1140
    PubMedSearch in Google Scholar
  • 13 Vuong ADB, Pham TH, Pham XTT. et al. Modified one-step conservative uterine surgery (MOSCUS) versus cesarean hysterectomy in the management of placenta accreta spectrum: a single-center retrospective analysis based on 619 Vietnamese pregnant women. Int J Gynaecol Obstet 2024; 165 (02) 723-736
    PubMedSearch in Google Scholar
  • 14 Abouda HS, Aloui H, Azouz E. et al. New surgical technique for managing placenta accreta spectrum and pilot study of the “CMNT PAS” study. AJOG Glob Rep 2024; 5 (01) 100430
    PubMedSearch in Google Scholar
  • 15 Munoz JL, Counts R, Lacue AE, Ireland KE, Ramsey PS, Brandi K. Surgical outcomes and associated morbidity of active and expectant management of second-trimester placenta accreta spectrum (PAS). Medicina (Kaunas) 2025; 61 (01) 113
    PubMedSearch in Google Scholar
  • 16 Bao Vuong AD, Thi Pham XT, Nguyen PN. The modified one-step conservative uterine surgery (MOSCUS) in the management of placenta accreta spectrum disorders: Which, where, when, and who. Taiwan J Obstet Gynecol 2023; 62 (04) 621-622
    PubMedSearch in Google Scholar
  • 17 Escobar MF, Gallego JC, Nasner D, Gunawardana K. Management of abnormal invasive placenta in a low- and medium-resource setting. Best Pract Res Clin Obstet Gynaecol 2021; 72: 117-128
    PubMedSearch in Google Scholar
  • 18 Nieto-Calvache AJ, Palacios-Jaraquemada JM, Hussein AM, Jauniaux E, Milani Coutinho C, Rijken M. Management of placenta accreta spectrum in low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 94: 102475
    PubMedSearch in Google Scholar
  • 19 Collins SL, Ashcroft A, Braun T. et al; European Working Group on Abnormally Invasive Placenta (EW-AIP). Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol 2016; 47 (03) 271-275
    CrossrefPubMedSearch in Google Scholar
  • 20 Cali G, Forlani F, Lees C. et al. Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound Obstet Gynecol 2019; 53 (06) 752-760
    CrossrefPubMedSearch in Google Scholar
  • 21 Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, Fox KA, Collins S. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2019; 146 (01) 20-24
    CrossrefPubMedSearch in Google Scholar
  • 22 Cui R, Li M, Lu J, Bai H, Zhang Z. Management strategies for patients with placenta accreta spectrum disorders who underwent pregnancy termination in the second trimester: a retrospective study. BMC Pregnancy Childbirth 2018; 18 (01) 298
    PubMedSearch in Google Scholar
  • 23 Mathur S, Chan WV, McGrattan M. et al. Minimally invasive management of second trimester placenta percreta. J Minim Invasive Gynecol 2022; 29 (10) 1136-1137
    PubMedSearch in Google Scholar
  • 24 Weydandt L, Lia M, Schöne A. et al. A Single-centre retrospective analysis of pregnancies with placenta accreta spectrum (PAS): from one-step surgery towards two-step surgical approach. J Clin Med 2024; 13 (11) 3209
    PubMedSearch in Google Scholar
  • 25 Li Q, Zhang W, Hu C. et al. Termination of a second-trimester pregnancy with placenta accreta spectrum disorder. Libyan J Med 2023; 18 (01) 2258669
    PubMedSearch in Google Scholar
  • 26 Hu Q, Li C, Luo L. et al. Clinical analysis of second-trimester pregnancy termination after previous caesarean delivery in 51 patients with placenta previa and placenta accreta spectrum: a retrospective study. BMC Pregnancy Childbirth 2021; 21 (01) 568
    PubMedSearch in Google Scholar
  • 27 Hessami K, Kamepalli S, Lombaard HA, Shamshirsaz AA, Belfort MA, Munoz JL. Conservative management of placenta accreta spectrum is associated with improved surgical outcomes compared to cesarean hysterectomy: a systematic review and meta-analysis. Am J Obstet Gynecol 2025; 232 (05) 432-452.e3
    PubMedSearch in Google Scholar
  • 28 Panaiotova J, Tokunaka M, Krajewska K, Zosmer N, Nicolaides KH. Screening for morbidly adherent placenta in early pregnancy. Ultrasound Obstet Gynecol 2019; 53 (01) 101-106
    PubMedSearch in Google Scholar
  • 29 Dar P, Doulaveris G. First-trimester screening for placenta accreta spectrum. Am J Obstet Gynecol MFM 2024; 6 (05) 101329
    PubMedSearch in Google Scholar
  • 30 Ho QN, Tran NH, Vuong ADB, Nguyen DV, Nguyen PN, Nguyen QHV. Successful management of cesarean scar pregnancy progressive to placenta accreta spectrum: an uncommon condition in Vietnam and mini-review of the literature. Int J Surg Case Rep 2025; 128: 111076
    PubMedSearch in Google Scholar
  • 31 Lucidi A, Janiaux E, Hussein AM. et al. Emergency delivery in pregnancies at high probability of placenta accreta spectrum on prenatal imaging: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2024; 6 (10) 101432
    PubMedSearch in Google Scholar
  • 32 Hobson SR, Kingdom JC, Murji A. et al. No. 383-screening, diagnosis, and management of placenta accreta spectrum disorders. J Obstet Gynaecol Can 2019; 41 (07) 1035-1049
    CrossrefPubMedSearch in Google Scholar