AJOG Expert Review: Nausicaä Suture in PAS — Step-by-Step Placement

AJOG Expert Review: The Nausicaä Suture in Placenta Accreta Spectrum — Step-by-Step Placement

Placenta accreta spectrum (PAS) remains one of the most challenging scenarios in obstetric surgery. Techniques that improve hemostasis and support uterine preservation—when appropriate—are valuable additions to the operative toolkit.

This post highlights an AJOG Expert Review on the Nausicaä suture and shares a practical, step-by-step way to think about its placement during cesarean in PAS.

Primary source: AJOG Expert Review — ‘The Nausicaä suture in the management of the placenta accreta spectrum: Step-by-step guide to placement’. Read here: https://ow.ly/GqA150YQ1rc

When this technique may be considered

The Nausicaä suture is described as a surgical hemostatic technique used in the management of PAS during cesarean delivery. As with any PAS strategy, patient selection, preoperative planning, and institutional readiness are critical.

• PAS cases where targeted uterine compression/hemostasis is needed as part of a broader operative plan

• Situations where the surgical team is pursuing uterine preservation and has appropriate expertise and resources

• As an adjunct to other hemostatic steps (uterotonics, uterine devascularization steps, tamponade, etc.) based on intraoperative findings

Always follow your local PAS protocol and multidisciplinary plan (anesthesia, blood bank, interventional radiology where applicable, urology/gynec-onc support).

Step-by-step: placement framework (high-level)

For the detailed operative steps and visuals, refer to the AJOG guide. Below is a structured framework you can use while reading it.

• Confirm the operative objective: hemostasis strategy and whether uterine preservation is intended

• Identify the bleeding source and the relationship of the placental bed to the hysterotomy and lower uterine segment

• Plan suture trajectory before passing the needle: entry/exit points, depth, and avoidance of adjacent structures

• Place the Nausicaä suture as described in the guide, maintaining consistent bite depth and spacing

• Tighten/compress gradually while reassessing bleeding and uterine contour

• Reassess: hemostasis, uterine tone, and need for additional measures (tamponade, additional sutures, devascularization, conversion to hysterectomy if required)

Practical pearls while learning the technique

• Use the article’s step images/diagrams to mentally rehearse the needle path before attempting in real cases.

• Keep a low threshold to escalate to definitive management if bleeding is uncontrolled.

• Document the intraoperative findings and steps clearly—especially in PAS where postoperative review and audit are important.

Read the full AJOG step-by-step

https://ow.ly/GqA150YQ1rc

Discussion

Have you used the Nausicaä suture (or a similar compression/hemostatic technique) in PAS? What were your key learning points? Share your experience in the comments.