ElNoury-Webster bundle: a preemptive surgical approach with a modified lower B-Lynch compression suture to manage morbidly low or adherent placenta

• Published in: The journal of maternal-fetal & neonatal medicine 2022-12, Vol.35 (25), p.1-8054
• Main Authors: ElNoury, Mohamed Amr H, Webster, Sophia Ne, Abdelhalim, Diaa A
• Format: Article
• Language: English
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2021.1940939

To report the technique and outcomes of a surgical care bundle, which preemptively and prophylactically reduces intrapartum bleeding during cesarean sections for these conditions and hence reducing the risk for a cesarean hysterectomy. In this report, we present the surgical and clinical outcomes of a case series of 16 patients presenting with a morbidly low or adherent placenta on whom this technique was piloted. Seven of the sixteen patients (44%) required a blood transfusion ranging from 1 to 5 units of packed RBCs. None of the neonates required neonatal unit admissions. One woman had a subsequent pregnancy, with normal placentation and an uncomplicated delivery by cesarean section. None of the patients in our series had a hysterectomy, needed to return to theater after the initial surgery or had secondary postpartum hemorrhage. The ElNoury-Webster Bundle is a stepwise surgical technique for the conservative management of morbidly low or adherent placenta particularly in low and middle-income healthcare settings.