Uterovesical tourniquet for conservative management of placenta accreta spectrum: a prospective cohort study in a low-resource setting.
Mousa A., Gaafar HM., Abdullah M., Elsherbini MM., Abdel-Rasheed M., Rida D., Saysaneh A., Collins SL., Abdelbar A.
BACKGROUND: Placenta accreta spectrum (PAS) is a condition affecting the placental detachment during labour and could be associated with life-threatening haemorrhage. We evaluated a novel uterovesical tourniquet technique to reduce blood loss during uterine sparing surgery. METHODS: This is a prospective cohort study that was conducted between 01/10/2023 and 01/04/2024, at Cairo University Hospital. Pregnant women with confirmed intra operative diagnosis of PAS were recruited to this study. The study included the application of a tourniquet around the lower part of the uterus and bladder before the delivery of the fetus to control blood loss during the operation. The primary outcomes were the operative procedure performed (Uterine sparing surgery Vs Caesarean Hysterectomy) and the measurement of the intraoperative blood loss. RESULTS: Twelve patients were included in this study. The average gestational age at deliver was 35.17 weeks ± 0.72. The uterine sparing surgery was successful in 11 out of the 12 patients (91.7%). The mean intraoperative blood loss was 950 mL ± 233.55 and the average operative time was 84.58 min ± 41.64. The mean number of packed RBCs units' transfused was 1.58 units ± 1.38. One bladder injury occurred. CONCLUSION: The uterovesical tourniquet may reduce haemorrhage in PAS, offering a feasible option for resource-limited settings. TRIAL REGISTRATION: This trial has been registered on clinicaltrials.gov with the identifier NCT06185894.