Cervical Tourniquet During Cesarean Section to Reduce Bleeding in Morbidly Adherent Placenta: a Pilot Study

Altal, Omar F.; Qudsieh, Suhair; Ben-Sadon, Abeer; Hatamleh, Assala; Bataineh, Adel; Halalsheh, Omar; Amarin, Zouhir

doi:10.2144/fsoa-2021-0087

Cited by 3 publications

(3 citation statements)

References 41 publications

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“…The use of a Foley catheter as a tourniquet during peripartum hysterectomy has emerged as a promising intervention for controlling hemorrhage in these intricate cases. Historically, a variety of strategies were introduced to handle excessive bleeding during peripartum hemorrhages, encompassing both nonsurgical techniques and surgical interventions such as uterine arterial ligation, embolization, and hemostatic suturing [ 8 , 9 , 10 , 18 ]. It is important to highlight that each method comes with its own set of limitations and risks.…”

Section: Discussionmentioning

confidence: 99%

“…Merging mechanical (tourniquet) and manual (forceps) techniques suggests a comprehensive approach to bleeding management, though it raises questions about potential tissue trauma or extended surgery duration. Altal et al [ 18 ] conducted a pilot study assessing the efficacy of a cervical tourniquet during cesarean deliveries in cases with morbidly adherent placenta. By centering on the cervix, this study illuminates a novel approach that could specifically address a primary source of bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, few publications currently explore this method. We found only four English-language articles on this subject, and they collectively discuss 23 patients who underwent perinatal hysterectomies due to PAS, using a Foley catheter as a tourniquet [ 15 , 16 , 17 , 18 ]. Our study aims to share our multi-year experience with the Foley catheter in reducing peripartum hemorrhage risks during hysterectomy for PAS patients.…”

Section: Introductionmentioning

confidence: 99%

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Foley Catheter as a Tourniquet for Hemorrhage Prevention during Peripartum Hysterectomy in Patients with Placenta Accreta Spectrum (PAS)—A Hospital-Based Study

Staniczek,

Manasar-Dyrbuś,

Winkowska

et al. 2023

Life

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Background: Placenta accreta spectrum (PAS) is a clinical entity significantly increasing the risk of a peripartum hemorrhage. Various surgical methods have been described in the literature, which aim to reduce the risk of bleeding, although they often lack reproducibility and have been performed on low numbers of patients. The aim of this study was to evaluate the use of the Foley catheter as a cervical tourniquet during cesarean sections, in patients with PAS. Methods: All patients who underwent peripartum hysterectomy due to PAS in a large single-center registry were included in the present analysis. The general demographics and clinical characteristics of all participants, including blood loss, and maternal and fetal outcomes, were collected and analyzed. Results: Twelve participants were included. The mean blood loss was 1200 ± 760 ml during operation and the mean ± SD procedural duration was 89 ± 17 min. The median (Q1–Q3) length of hospital stay post-procedurally was 5 (4–6) days. None of the patients required subsequent urgent surgical procedures after hysterectomy. The median (Q1–Q3) packed red blood cell units transfused in our cohort was 2 (0–3). Conclusion: Using the Foley catheter as a tourniquet might be an effective method of excessive bleeding prevention in patients with PAS during peripartum hysterectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Foley Catheter as a Tourniquet for Hemorrhage Prevention during Peripartum Hysterectomy in Patients with Placenta Accreta Spectrum (PAS)—A Hospital-Based Study

Staniczek,

Manasar-Dyrbuś,

Winkowska

et al. 2023

Life

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Uterine isthmic tourniquet left in situ as a new approach for placenta previa-accreta surgery: a comparative study

Bağlı,

Öcal,

Bala

et al. 2024

Journal of Perinatal Medicine

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Objectives Placenta previa-accreta spectrum disorders are a cause of obstetric hemorrhage that can lead to maternal fetal mortality and morbidity. We aimed to describe the use of a uterine isthmic tourniquet left in situ as a new uterus-preserving approach for patients with placenta previa-accreta. Methods In this retrospective comparative study, the patients who underwent surgery for placenta previa between 2017 and 2024 at our tertiary hospital were reviewed. Primary outcome of the study is to evaluate feasibility of uterine isthmic tourniquet left in situ for uterine preserving by preventing postpartum hemorrhage for patients with placenta previa-accreta. As a secondary outcome, group 1 (n=28) patients who were managed with uterine isthmic tourniquet left in place were compared with patients in group 2 (n=32) who were managed with only bilateral uterine artery ligation. Results This new approach uterine isthmic tourniquet technique prevented postpartum hemorrhage with a rate of 100 percent in group 1 patients, while uterine artery ligation prevented postpartum hemorrhage with a rate of 75 % in group 2. Postoperative additional interventions (relaparotomy hysterectomy, balloon tamponade application, uterine or vaginal packing) were performed for eight patients in group 2 (25 %) but not in group 1 (0 %) (p=0.015). The haemoglobin levels before caesarean section were similar in both groups (p=0.235), while the postoperative haemoglobin levels were lower in group 2 (9.69 ± 1.37 vs. 8.15 ± 1.32) (p=0.004). Erythrocyte suspension was given to two patients in group 1 and 12 patients in group 2 (2/28 7 % vs. 12/32 37 %, p=0.018). Conclusions The uterine isthmic tourniquet left in situ technique is a safe, simple and effective for preventing postpartum hemorrhage and preserving uterus during placenta previa accreta surgery as superior to uterine artery ligation alone.

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Foley Catheter as a Tourniquet for Peripartum Hemorrhage Prevention in Patients with Placenta Accreta Spectrum—A Two Case Report and a Review of the Literature

et al. 2023

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One of the most perilous complications in obstetrics, often leading to severe bleeding and sometimes a need for urgent hysterectomy, is placenta accreta spectrum, which significantly increases the risk of peri-partum complications, even including the risk of death for the mother and the child. Dealing with excessive bleeding in this situation is paramount. We have found a Foley catheter tourniquet to be useful as a temporary tourniquet to control placental and uterine hemorrhage. We have used this method and find it very useful. In this publication, we describe the last two cases of the use of the Foley catheter as a tourniquet for peri-partum hemorrhage prevention, and we will present a review of the literature in this field.

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Cervical Tourniquet During Cesarean Section to Reduce Bleeding in Morbidly Adherent Placenta: a Pilot Study

Cited by 3 publications

References 41 publications

Foley Catheter as a Tourniquet for Hemorrhage Prevention during Peripartum Hysterectomy in Patients with Placenta Accreta Spectrum (PAS)—A Hospital-Based Study

Foley Catheter as a Tourniquet for Hemorrhage Prevention during Peripartum Hysterectomy in Patients with Placenta Accreta Spectrum (PAS)—A Hospital-Based Study

Uterine isthmic tourniquet left in situ as a new approach for placenta previa-accreta surgery: a comparative study

Foley Catheter as a Tourniquet for Peripartum Hemorrhage Prevention in Patients with Placenta Accreta Spectrum—A Two Case Report and a Review of the Literature

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