Hemostatic Compression Treatment of Central Placenta Previa with Modified Cho Suture

Background and Introduction: Placenta previa occurs when the placental edge lies within 2 cm of the internal cervical orifice. In early pregnancy, most cases resolve spontaneously by the third trimester. Placenta previa increases the risk of placenta accreta, especially in women with prior cesarean delivery, uterine surgery, or advanced maternal age. Patients with central placenta previa typically undergo elective cesarean section. Hemorrhagic complications are common even in the absence of accreta. Uterine compression sutures, particularly Cho sutures, are used to manage postpartum hemorrhage and may be modified to address case-specific challenges. Case Presentation: A 46-year-old woman conceived through IVF and had an uneventful pregnancy. A third-trimester ultrasound confirmed central placenta previa. An elective cesarean section was scheduled at 38 weeks due to advanced maternal age. A healthy newborn was delivered. Manual removal of the placenta was difficult, and bleeding from the placental bed persisted. Due to the midline location of the bleeding vessels, standard Cho sutures were avoided to prevent cervical canal closure. Instead, modified Cho compression sutures were applied solely to the posterior uterine wall using resorbable monofilament, achieving effective hemostasis. Discussion and Conclusion: This case highlights the importance of early diagnosis and individualized surgical planning in managing placenta previa. Modified compression sutures, when performed by experienced hands, can be adapted to control hemorrhage effectively, reducing the need for more invasive interventions and preserving uterine integrity.