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

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.