Efficacy of Tourniquet Application in Minimizing Intraoperative Blood Loss in Cesarean Hysterectomies for Placenta Accreta—A Comparative Study

摘要

Objective: To assess the effect of tourniquet application of intraoperative blood loss in placenta accreta cases undergoing cesarean hysterectomy. Materials and methods: Nine cases and twenty controls with USG and colour Doppler diagnosed placenta accreta with previous cesarean section were chosen to utilize this novel approach. These cases were planned for elective cesarean section followed by hysterectomy. The twenty controls underwent a classical cesarean section followed by total abdominal hysterectomy with the placenta?in situ. Among the nine cases, after delivery of the fetus through upper segment cesarean section, a cotton gauze tourniquet was applied all around the lower pole of uterus. Hysterectomy was performed with placenta?in situ. Abdomen closed after achieving complete haemostasis. Results: The average operative time taken was 85 ± 11.72 minutes among cases and 98.25 ± 9.9 minutes among controls (p = 0.0039). Average blood loss was 1011.11 ± 99.3 ml among the cases and 1855 ± 222.95 ml among the controls (p ≤ 0.0001). Average requirement of blood transfusion required was two units for the cases and five units for the controls (p = 0.0002). No intra-operative or post-operative surgical complications were observed in any of the cases whereas the controls reportedly had a few. All the mothers and babies were healthy at the time of discharge. Conclusion: The presence of placenta accreta is associated with major fetal and maternal complications. The technique of tourniquet application is efficacious in minimizing the intra-operative blood loss and surgical complications due to obstruction of operative field by bleeding and also by preventing massive blood transfusion related complications.