A novel hemostatic suture technique for uterine rupture complicated by placenta accreta spectrum

Rationale: Uterine rupture secondary to the placenta accreta spectrum (PAS) is a life-threatening obstetric emergency. Intractable massive hemorrhage in this setting often necessitates emergent hysterectomy, while effective fertility-sparing surgical options for such critical bleeding remain limited. This report highlights the utility of a novel suturing technique for achieving effective hemostasis and fertility preservation in patients with PAS-related uterine rupture. Patient concerns: A 36-year-old Asian woman diagnosed with PAS presented with spontaneous uterine rupture at 16+ weeks of gestation, complicated by severe refractory intra-abdominal hemorrhage. Diagnoses: The diagnosis of PAS-related uterine rupture was confirmed based on the patient’s previous cesarean delivery history, clinical manifestations, preoperative imaging findings, and postoperative pathological results. Interventions: A novel technique combining anteroposterior traction and bilateral reinforcement sutures of the lower uterine segment was applied for hemostasis, with an estimated intraoperative blood loss of 400 mL. Outcomes: The patient recovered uneventfully and was discharged on postoperative day (POD) 11; regular menses persisted at 1-year follow-up. Lessons: PAS-related uterine rupture is easily misdiagnosed or delayed owing to variable clinical presentations. Conventional hemostatic approaches are often ineffective for refractory severe hemorrhage. This novel combined suturing technique offers a simple, feasible fertility-sparing strategy to avoid unnecessary hysterectomy and improve maternal outcomes in catastrophic obstetric bleeding.