Key result
Adding placental bed suturing to balloon tamponade is linked to ~3.2-fold higher severe postpartum hemorrhage risk.
Why the study?
To examine the effectiveness of placental bed sutures and compare estimated blood loss between placenta previa patients receiving intrauterine balloon tamponade alone versus balloon tamponade plus placental bed suturing.
Does suturing the placental bed in addition to intrauterine balloon tamponade reduce estimated blood loss in placenta previa patients with postpartum hemorrhage?
Cohort (n=118)
No
Does suturing the placental bed in addition to intrauterine balloon tamponade reduce estimated blood loss in placenta previa patients with postpartum hemorrhage?
Effect estimate: OR 3.2 (95% CI 1.2-8.5)
p-value: p=0.017
Administration of intrauterine balloon tamponade without suturing the placental bed may be sufficient to manage postpartum hemorrhage in low-risk placenta previa patients, as additional suturing was associated with higher estimated blood loss.
May support adjunctive placental bed sutures in PP-PPH; leaves open confirmation in RCTs.
BACKGROUND: This study aimed to examine the effectiveness of placental bed sutures in placenta previa (PP) patients and compare the amount of estimated blood loss (EBL) in patients who were only applied intrauterine balloon tamponade (IUBT) with the patients who were applied suturing to the placental bed in addition to IUBT. METHODS: PP patients (n:118) who were applied IUBT for postpartum hemorrhage (PPH) were the inclusion criteria. PP patients who were only applied IUBT constituted the suture-negative group (n:65) and the patients who were applied suturing to the placental bed in addition to IUBT constituted the suture-positive group (n:53). Clinicodemographic features, transfused blood and/or blood products, uterotonics used, EBL, and the volume IUBT inflated, and the duration of IUBT, were recorded and compared between the groups. RESULTS: The median volume IUBT inflated was 200 (160-460) mL and the median duration of IUBT was 12 (6-24) hours in PP patients. The amount of EBL was shown to be higher in suture-positive group (p = 0.003). Multivariate logistic regression analysis revealed that presence of suturing the placental bed was associated with severe PPH (p = 0.017). CONCLUSIONS: IUBT, is a successful method that is easily applicable, and administration of IUBT without suturing the placental bed may be sufficient to manage PPH in low-risk PP patients.
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Ersak et al. (2026) conducted a cohort in Placenta previa with postpartum hemorrhage (n=118). Suturing the placental bed in addition to intrauterine balloon tamponade vs. Intrauterine balloon tamponade alone was evaluated on Severe postpartum hemorrhage (Estimated blood loss ≥1000 mL) (OR 3.2, 95% CI 1.2-8.5, p=0.017). Suturing the placental bed in addition to intrauterine balloon tamponade was associated with a 3.2-fold increased risk of severe postpartum hemorrhage compared to balloon tamponade alone in placenta previa patients.
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