Uterine isthmic tourniquet left in situ as a new approach for placenta previa-accreta surgery: a comparative study
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İhsan Bağlı
,
Ece Öcal
Abstract
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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Research ethics: This study was conducted in compliance with the Helsinki Declaration Rules, following approval from the ethics committee of the hospital (date: June 27, 2023 and number: 415).
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Informed consent: Not applicable.
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Author contributions: All authors have reviewed and approved the manuscript for publication. İB was the project administrator and contributed to the supervision, resources, methodology, and literature review, writing and statistical analysis. EÖ contributed to conceptualization, validation, software, methodology, and literature review. MB contributed to investigation, supervision, resources, methodology, and literature review. ZT contributed to data curation. MSB contributed for checking statistical analysis. MAH contributed to the literature review, resources, data curation. CB contributed to the literature review, resources and EG contributed to data curation. All authors agree to be accountable for all aspects of the work, ensuring integrity and accuracy.
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Competing interests: The authors state that they have no conflicts of interest.
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Research funding: None declared.
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Data availability: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
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© 2024 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review
- Chorioamnionitis and respiratory outcomes in prematurely born children: a systematic review and meta analysis
- Opinion Paper
- Non-binary patients in ART: new challenges and considerations
- Corner of Academy
- KANET evaluation in patients with SARS-CoV-2
- Original Articles – Obstetrics
- Socioeconomic status as a risk factor for SARS-CoV-2 infection in pregnant women
- Social vulnerability and prenatal diagnosis
- Perinatal outcomes in pregnant women with ITP: a single tertiary center experience
- Ability of an obstetric hemorrhage risk assessment tool to predict quantitative peripartum blood loss
- Sensitive detection of hemodynamic changes after fetoscopic laser photocoagulation by assessing intraventricular pressure difference in fetuses with twin-to-twin transfusion syndrome
- Prevalence of restless legs syndrome during pregnancy and postpartum period
- Does atenolol use during pregnancy cause small for gestational age neonates? A meta-analysis
- Uterine isthmic tourniquet left in situ as a new approach for placenta previa-accreta surgery: a comparative study
- Maternal and newborn outcomes in pregnancies complicated by Guillain-Barré syndrome
- Original Articles – Fetus
- A customised fetal growth and birthweight standard for Qatar: a population-based cohort study
- Molecular analysis of 31 cases with fetal skeletal dysplasia
- Short Communication
- Current practice of ultrasound in the management of postpartum hemorrhage: a secondary analysis of a national survey
Artikel in diesem Heft
- Frontmatter
- Review
- Chorioamnionitis and respiratory outcomes in prematurely born children: a systematic review and meta analysis
- Opinion Paper
- Non-binary patients in ART: new challenges and considerations
- Corner of Academy
- KANET evaluation in patients with SARS-CoV-2
- Original Articles – Obstetrics
- Socioeconomic status as a risk factor for SARS-CoV-2 infection in pregnant women
- Social vulnerability and prenatal diagnosis
- Perinatal outcomes in pregnant women with ITP: a single tertiary center experience
- Ability of an obstetric hemorrhage risk assessment tool to predict quantitative peripartum blood loss
- Sensitive detection of hemodynamic changes after fetoscopic laser photocoagulation by assessing intraventricular pressure difference in fetuses with twin-to-twin transfusion syndrome
- Prevalence of restless legs syndrome during pregnancy and postpartum period
- Does atenolol use during pregnancy cause small for gestational age neonates? A meta-analysis
- Uterine isthmic tourniquet left in situ as a new approach for placenta previa-accreta surgery: a comparative study
- Maternal and newborn outcomes in pregnancies complicated by Guillain-Barré syndrome
- Original Articles – Fetus
- A customised fetal growth and birthweight standard for Qatar: a population-based cohort study
- Molecular analysis of 31 cases with fetal skeletal dysplasia
- Short Communication
- Current practice of ultrasound in the management of postpartum hemorrhage: a secondary analysis of a national survey
