LAUSR

The article we had published in Arch Gynecol Obstet (2020) 301:465–472 had introduced a surgical procedure of transverse parallel compression suture to deal with pernicious placenta previa during cesarean section; now, we have improved our procedure with readily available materials. This technique, first of all, is safe and uterine reserving, turns out to be an easy performing, short surgical time, few blood loss and lower cost one. In hospital of insufficient blood supply, prophylactic use of this technique can greatly reduce blood loss in cesarean section for placenta previa and decrease the incidence of postpartum hemorrhage. It can also be used in various obstetric hemorrhage. Herein, we have detailed the improved technique for better performance. Before cesarean section (CS) for patients of placenta previa and/or placenta accreta, the leading surgeon should have carefully reviewed the medical history and image materials, predesigned the incision. In cases of placenta accreta involved bladder or other adjacent organ, multidisciplinary team are needed and pelvic devascularization of preoperative placement of iliac balloon catheters should be considered, it can be unified with our procedure. Cell salvage was used for autologous blood transfusion during the surgery. Prepared two rubber tape (like drainage tube) and uterine draining balloon: take down the interface of endotracheal tube (type 7.0), and 10–20 mL air inflated to the balloon, put the interface of air inflation to the tube (Fig. 1). After laparotomy, partly open the avascular part of reflex peritoneum overlying the anterior lower uterine segment (LUS) and dissect as possible. Selected a high transverse or vertical incision of LUS to avoid main adherence of placenta as possible. Quickly deliver the baby and ligate the cord. Exteriorization of the uterus, then a rubber tape bundles up near to the cervix, and be sure of the whole placenta above the tap, then tension the tape to temporary cut down the blood supply of uterus (this step can be omitted with preoperative placement of iliac balloon catheters). In addition, another rubber tape bundles up the uterine cavity near the uterine fundus to temporary blocking ovarian branch of uterine artery, then remove the placenta integrally. Insert the draining balloon into uterus from internal to the external os, as a support for compressing and draining, then the balloon portion is put into the cavity (Fig. 2). Pulling upward the uterus, at the upside of the tape, a stitch with 1–0 absorbable VICRYL is inserted borderline of myometrium from the anterior to the posterior at the operator’s side. The stitch was then inserted borderline of the myometrium from the posterior to anterior at the other side in the horizontal direction and tightened at the anterior wall of uterine surface. The operators should carefully feel the borderline of uterus and the parametrial vessels to make sure that the stitch does not involve the vessels. Another suture is inserted superiorly at about 1 cm interval. Then the uterine incision is stitched normally with one or double sutures. More such parametrial sutures are performed as required. Untie two tapes, push down the reflex peritoneum of LUS until the internal os of cervix, additional parametrial sutures can be performed to make sure that the placenta implanted location has been compressed (Fig. 3). Gently replace the uterus into abdomen. After careful hemostasis, suture the reflex peritoneum and place an This comment refers to the article available at doi:https ://doi. org/10.1007/s0040 4-020-05435 -3.