Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana.
Department of Obstetrics and Gynecology, Walter Sisulu University and Eastern Cape Department of Health, Mthatha, South Africa.
Gynecol Obstet Invest. 2021;86(6):549-553. doi: 10.1159/000520643. Epub 2021 Nov 4.
Hemorrhage from a partially or fully detached placenta with an advanced abdominal pregnancy can be profuse and catastrophic. The general approach to placental management is removal of "all or nothing." In the event of acute hemorrhage, attempts to achieve hemostasis quickly are critical. We have found a Foley catheter tourniquet to be useful to control placental hemorrhage or as a temporary tourniquet applied around structures surrounding the implantation site to aid placental removal. We report use of the technique on 4 occasions with good surgical outcomes.
We report the case of a 33-year-old primigravid woman admitted at term with ultrasound diagnosis of breech presentation and placenta previa grade 4. Her preoperative clinical assessment, however, raised suspicion of an abdominal pregnancy. At laparotomy, a live female infant was delivered from the extra-uterine gestation sac, weighing 3,640 g and with Apgar scores of 7 and 6 at 1 and 5 min, respectively. Following delivery, there was profuse bleeding from the partially detached distal portion of the placenta that derived a rich blood supply from the poorly accessible posterior pelvic wall. We applied a novel, simple, and effective surgical technique for minimizing blood loss from the partially detached placenta using a Foley's catheter tourniquet that was applied between the detached and still attached parts of the placenta. The tourniquet was left in situ and removed at laparotomy 4 days later. The placenta was not removed. The mother and baby did well postoperatively and were discharged after 10 and 21 days, respectively, in good condition. The surgical technique was used in 3 additional cases with good clinical outcomes.
Use of a Foley catheter as an intraoperative tourniquet has become accepted as a useful technique in obstetric and gynecological surgery. We describe a simple life-saving technique of applying a Foley tourniquet across a partially detached placenta following an advanced extra-uterine pregnancy to control acute hemorrhage.
We recommend that surgeons keep in mind the option of intraoperative tourniquets when faced with uncontrollable bleeding as a short-term or medium-term temporizing measure.
部分或完全分离的胎盘伴晚期腹内妊娠出血可能大量且灾难性。胎盘处理的一般方法是“全部或全无”。一旦发生急性出血，迅速止血至关重要。我们发现 Foley 导管止血带在控制胎盘出血或作为围绕植入部位周围结构施加的临时止血带以帮助胎盘移除时非常有用。我们报告了 4 例使用该技术的病例，手术结果良好。
我们报告了 1 例 33 岁初产妇，因超声诊断臀位和 4 级前置胎盘入院。然而，她术前的临床评估提示腹内妊娠的可能性。剖腹产后，从宫外妊娠囊中分娩出一名活女婴，体重 3640 克，出生后 1 分钟和 5 分钟的 Apgar 评分为 7 分和 6 分。分娩后，部分分离的胎盘远端有大量出血，这些胎盘从难以触及的骨盆后壁获得丰富的血液供应。我们采用了一种新颖、简单、有效的手术技术，使用 Foley 导管止血带在部分分离的胎盘与仍附着的胎盘之间施加止血带，以尽量减少胎盘部分分离引起的出血。止血带留在原位，4 天后在剖腹术中取出。胎盘未被移除。母亲和婴儿术后恢复良好，分别在 10 天和 21 天后出院，情况良好。该手术技术还在另外 3 例病例中得到了良好的临床效果。
在产科和妇科手术中，使用 Foley 导管作为术中止血带已被广泛接受为一种有用的技术。我们描述了一种在晚期宫外妊娠后应用 Foley 止血带横跨部分分离胎盘以控制急性出血的简单救生技术。
当面临无法控制的出血时，我们建议外科医生考虑使用术中止血带作为短期或中期临时措施。
