Department of Obstetrics and Gynecology, University of Health Sciences Diyarbakir Gazi Yaşargil Egitim Araştırma Hastanesi Ek Bina, Urfa Yolu, Bağlar, 21090, Diyarbakır, Türkiye.
Private Clinic of Perinatology, Diyarbakır, Türkiye.
J Perinat Med. 2024 Aug 5;52(8):863-869. doi: 10.1515/jpm-2024-0243. Print 2024 Oct 28.
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 as a new uterus-preserving approach for patients with placenta previa-accreta.
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 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.
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).
The uterine isthmic tourniquet left 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.
胎盘前置-粘连谱系疾病是导致产科出血的原因之一，可导致母婴死亡率和发病率增加。我们旨在描述使用子宫峡部止血带作为一种新的保留子宫方法，用于治疗胎盘前置-粘连患者。
在这项回顾性对比研究中，我们回顾了 2017 年至 2024 年期间在我们的三级医院接受胎盘前置手术的患者。该研究的主要结果是评估通过防止胎盘前置-粘连患者产后出血来保留子宫的左侧子宫峡部止血带的可行性。作为次要结果，将使用左侧子宫峡部止血带（组 1，n=28）的患者与仅接受双侧子宫动脉结扎（组 2，n=32）的患者进行比较。
这种新的子宫峡部止血带技术在组 1 患者中防止产后出血的成功率为 100%，而在组 2 患者中，子宫动脉结扎防止产后出血的成功率为 75%。组 2 中有 8 名患者（25%）需要进行额外的干预措施（剖腹子宫切除术、球囊填塞应用、子宫或阴道填塞），而组 1 中没有（0%）（p=0.015）。两组患者剖宫产前的血红蛋白水平相似（p=0.235），但组 2 的术后血红蛋白水平较低（9.69±1.37 比 8.15±1.32）（p=0.004）。组 1 中有 2 名患者和组 2 中有 12 名患者需要输注红细胞悬液（2/28，7%比 12/32，37%）（p=0.018）。
与单独使用子宫动脉结扎相比，左侧子宫峡部止血带技术是一种安全、简单、有效的预防胎盘前置-粘连手术中产后出血和保留子宫的方法。
