TITLE:
Efficacy of Tourniquet Application in Minimizing Intraoperative Blood Loss in Cesarean Hysterectomies for Placenta Accreta—A Comparative Study
AUTHORS:
Pushplata Sankhwar, Shyam Pyari Jaiswar, Sujata Deo, Devyani Misra, Neha Negi
KEYWORDS:
Placenta Accreta, Post-Partum Haemorrhage, Tourniquet
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.16,
December
5,
2014
ABSTRACT: 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 placentain 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 placentain
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.