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

Objective 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. Methods 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. Results 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. Conclusions 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.

Automated summary

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. The technique was piloted on 16 patients with positive outcomes, showing a reduced risk for cesarean hysterectomy and postpartum hemorrhage. No patients in the series required hysterectomy, return to theater after initial surgery, or experienced secondary postpartum hemorrhage.