Objective:To evaluate the clinical feasibility and safety of uterine suture with tourniquet binding during cesarean delivery for placenta previa with placenta accreta spectrum (PAS) grades 2-3a.Methods:This retrospective cohort study included 62 patients with placenta previa and PAS grades 2-3a who underwent cesarean section at the First Affiliated Hospital of Kangda College of Nanjing Medical University (the First People's Hospital of Lianyungang) from June 2018 to June 2023. Participants were divided into two groups according to vascular occlusion method: 31 patients receiving uterine suture with aortic balloon and/or uterine artery embolization comprised the intervention group, while 31 patients undergoing uterine suture with rubber tourniquet binding constituted the tourniquet group. Clinical characteristics and outcomes were compared, including operative duration, 24-hour postoperative blood loss, postoperative hospitalization, costs (hospitalization and 24-hour transfusion), early complications (late postpartum hemorrhage, fever, disseminated intravascular coagulation, organ injury), and late complications (menstrual changes, pelvic pain, urinary tract infections within 6-12 months). Statistical analyses employed two independent t-tests, Mann-Whitney U tests, and Chi square tests. Results:(1) Baseline characteristics, including maternal age, gestational weeks at delivery, gravidity and parity, number of previous cesarean deliveries, hemoglobin levels within 24 hours before surgery, neonatal birth weight, or proportion of emergency surgeries, showed no significant differences between the two groups (all P>0.05). (2) The tourniquet group demonstrated shorter operative duration [(118.3±38.2) vs. (180.7±66.6) min, t=3.87, P<0.001] and postoperative hospitalization [(5.9±1.7) vs. (7.6±2.2) d, t=3.04, P=0.002], with lower hospitalization costs [20 000 (15 000-23 000) vs. 44 000 (34 000-52 000) CNY, Z=5.92, P<0.001] and 24-hour transfusion costs [1 300.0 (1 207.5-2 400.0) vs. 2 828.0 (1 634.5-5 657.7) CNY, Z=2.90, P=0.004]. Early complication rates were significantly reduced [6.5% (2/31) vs. 35.5% (11/31), χ2=7.88, P=0.005], while 24-hour blood loss [1 574.2 (900.0-2 000.0) vs. 1 990.3 (1 000.0-2 500.0) ml, Z=1.37, P=0.172] and late complication rates [25.8% (8/31) vs. 32.3% (10/31), χ2=0.48, P=0.399] showed no significant differences. Conclusion:For placenta previa with PAS grades 2-3a, tourniquet-binding uterine suture effectively controls hemorrhage, reduces operative time, hospitalization duration, and costs, representing a safe and efficient surgical approach.

Objective:To evaluate the clinical feasibility and safety of uterine suture with tourniquet binding during cesarean delivery for placenta previa with placenta accreta spectrum (PAS) grades 2-3a.Methods:This retrospective cohort study included 62 patients with placenta previa and PAS grades 2-3a who underwent cesarean section at the First Affiliated Hospital of Kangda College of Nanjing Medical University (the First People's Hospital of Lianyungang) from June 2018 to June 2023. Participants were divided into two groups according to vascular occlusion method: 31 patients receiving uterine suture with aortic balloon and/or uterine artery embolization comprised the intervention group, while 31 patients undergoing uterine suture with rubber tourniquet binding constituted the tourniquet group. Clinical characteristics and outcomes were compared, including operative duration, 24-hour postoperative blood loss, postoperative hospitalization, costs (hospitalization and 24-hour transfusion), early complications (late postpartum hemorrhage, fever, disseminated intravascular coagulation, organ injury), and late complications (menstrual changes, pelvic pain, urinary tract infections within 6-12 months). Statistical analyses employed two independent t-tests, Mann-Whitney U tests, and Chi square tests. Results:(1) Baseline characteristics, including maternal age, gestational weeks at delivery, gravidity and parity, number of previous cesarean deliveries, hemoglobin levels within 24 hours before surgery, neonatal birth weight, or proportion of emergency surgeries, showed no significant differences between the two groups (all P>0.05). (2) The tourniquet group demonstrated shorter operative duration [(118.3±38.2) vs. (180.7±66.6) min, t=3.87, P<0.001] and postoperative hospitalization [(5.9±1.7) vs. (7.6±2.2) d, t=3.04, P=0.002], with lower hospitalization costs [20 000 (15 000-23 000) vs. 44 000 (34 000-52 000) CNY, Z=5.92, P<0.001] and 24-hour transfusion costs [1 300.0 (1 207.5-2 400.0) vs. 2 828.0 (1 634.5-5 657.7) CNY, Z=2.90, P=0.004]. Early complication rates were significantly reduced [6.5% (2/31) vs. 35.5% (11/31), χ2=7.88, P=0.005], while 24-hour blood loss [1 574.2 (900.0-2 000.0) vs. 1 990.3 (1 000.0-2 500.0) ml, Z=1.37, P=0.172] and late complication rates [25.8% (8/31) vs. 32.3% (10/31), χ2=0.48, P=0.399] showed no significant differences. Conclusion:For placenta previa with PAS grades 2-3a, tourniquet-binding uterine suture effectively controls hemorrhage, reduces operative time, hospitalization duration, and costs, representing a safe and efficient surgical approach.