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. 2024 Feb 2:21:100285.
doi: 10.1016/j.eurox.2024.100285. eCollection 2024 Mar.

Tourniquet on the low segment of the uterus reduces blood loss in postpartum hemorrhage during hysterectomy for placenta accreta: Old but gold

Hassine S Abouda  1 , Sofiene B Marzouk  2 , Yecer Boussarsar  2 , Haithem Aloui  1 , Hatem Frikha  1 , Rami Hammami  1 , Badis Chennoufi  1 , Hayen Maghrebi  2
Affiliations

Tourniquet on the low segment of the uterus reduces blood loss in postpartum hemorrhage during hysterectomy for placenta accreta: Old but gold

Hassine S Abouda et al. Eur J Obstet Gynecol Reprod Biol X. .

Abstract

Objectives: To investigate the feasibility, safety, and efficiency after application of a cervical tourniquet during caesarian hysterectomy owing to placenta accreta.

Study design: It was a monocentric prospective observational study for 3 years. Patients were allocated into two group: Group Tourniquet: (TG) in which a cervical tourniquet was systematically applied during hysterectomy, control group (CG) when the caesarian hysterectomy was performed without.

Results: 20 patients in the TG and 23 patients in the CG. Tourniquet application significantly reduced per operative estimated blood loss volume (TG: 530 ± 135 vs 940 ± 120 ml in the CG, p = 0.0074), ΔHB (0.6 [0.3-1.9] vs 2.5[2.5-3.6] g/dl in the CG, p = 0.006) RBC transfusion requirements' (TG: 2 ± 1.7 vs 4.3 ± 2.1 units in the CG, p = 0.046) procedure duration (TG: 98 ± 21 vs 137 ± 33 min in the CG, p = 0.015), clotting disorders (TG: 1 (5%) vs 6 (26,1%) in the CG, p = 0.013) and the incidence of bladder wounds (TG: 1 (5%) vs 5 (21,7%) in the CG, p = 0.048). There was no significant difference regarding ICU transfer rate (TG: 16 (80%) vs 20 (86.9%) in the CG, p = 0.53) or length of stay (TG: 1.4 [2,3] vs 2.3 [1-4] days in the CG, p = 0.615) and digestive wound (TG: 0 vs 2 (8,7%) in the CG, p = 0.641).

Conclusion: In case of a radical management of placenta accreta. A strategy that involves the application of a cervical Tourniquet should be considered as a feasible, safe and above all efficient alternative to prevent blood spoliation.

Keywords: Blood loss; Hemoglobin variation; Maternal morbidity; Placenta accreta; Postpartum hemorrhage; Tourniquet.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Tourniquet application main steps (A) Suturing hysterotomy (blue arrow) with placenta kept in place. (B) Hysterectomy started with the Foley catheter as tourniquet in the lower segment of the uterus (blue arrow). (C) Last steps before completing hysterectomy (blue arrow).
See this image and copyright information in PMC

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