Abstract / Summary
Bleeding from the lower uterine segment is difficult to control during cesarean delivery for placenta previa, and conventional compression sutures were designed mainly for uterine atony.We systematically reviewed comparative studies of lower uterine segment compression sutures, focusing on hemostatic success and uterine preservation.Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, PubMed, Scopus, Web of Science, and Embase were searched through 12 September 2026.Original comparative studies from the last five years that included women with placenta previa undergoing cesarean delivery were eligible.Risk of bias was assessed with the Risk of Bias in Non-randomized Studies -of Interventions (ROBINS-I).Because techniques and comparators differed, results were synthesized narratively without pooling.Of 183 records identified, four retrospective comparative cohorts (91-346 women) were included.In the two studies reporting mean blood loss, suture groups lost less blood than comparators (2152.6 versus 2960.5 mL; 792.5 versus 1220.8 mL).Operative times were shorter, and fewer additional procedures were needed.Hysterectomy was infrequent: none occurred with double-row transfixion versus two with aortic balloon plus sutures.Two studies had a low overall risk of bias and two a serious risk.Lower uterine segment sutures appear to be a useful, low-cost hemostatic option in placenta previa, but the evidence is limited to four retrospective cohorts.Prospective comparative studies with standardized outcomes are needed.