Cervical Tourniquet During Cesarean Section to Reduce Bleeding in Morbidly Adherent Placenta: a Pilot Study

Abstract

Objective: To evaluate a modified surgical technique aiming to reduce bleeding and preserve fertility in morbidly adherent placenta by cervical tourniquet in cesarean sections. Methods: The cesarean section operations and the cervical ligation approach were performed by a single expert consultant obstetrician. The general demographics and clinical characteristics for all participants were collected and studied. Results: Eleven participants were involved. The uterus was preserved in nine patients, whereas two patients had hysterectomy. The mean blood loss was 1688.8 ml for patients whose uterus was preserved. The mean length of stay was 5.5 days. Conclusion: Cervical ligation is a simple method that can be applied by junior and experienced obstetricians to preserve the uterus.

Plain Language Summary

Placenta accreta is the abnormal adhesion of placenta into the uterine wall. It carries a significant risk for hysterectomy, intrapartum and postpartum hemorrhage, and maternal morbidity and mortality. As the preservation of fertility and femininity is desired by many women, numerous methods were adapted to avoid hysterectomy in patients with placenta accreta. In this study, we describe and evaluate a novel technique to preserve the uterus by ligating the cervix with a Foley catheter.

Keywords:

• cervical ligation
• cesarean section
• hysterectomy
• placenta accreta
• uterine artery ligation

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at:www.tandfonline.com/doi/full/10.2217/epi-2016-0184

Author contributions

All authors contributed significantly and are in agreement with the content of the article. All authors were involved in project design, data collection, analysis, statistical analysis, data interpretation and writing the manuscript. All authors presented substantial contributions to the article and participated in correction and final approval of the version to be submitted.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Availability data & materials

The datasets generated and analyzed during the current study are available from the corresponding author.

Ethical conduct of research

This study was reviewed and approved by the Institutional Review Board of King Abdullah University Hospital and Jordan University of Science and Technology. This study was conducted in accordance with the Declaration of Helsinki. We confirm that the privacy of the participants was saved, and the data was anonymized and maintained with confidentiality. Written informed consent was obtained from all patients in this study. The authors also confirm that written informed consent was obtained from the patient in Supplementary Video 1 for the article and for the video.