Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular Control
Objective: To evaluate the use of tourniquet and forceps to reduce bleeding during surgical treatment of severe placenta accreta spectrum (placenta increta and placenta percreta).Methods: A tourniquet was used in the lower part of the uterus during surgical treatment of severe placenta accreta spect...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.557678/full |
| _version_ | 1818926230607495168 |
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| author | Jingrui Huang Xiaowen Zhang Lijuan Liu Si Duan Chenlin Pei Yanhua Zhao Rong Liu Weinan Wang Yu Jian Yuelan Liu Hui Liu Xinhua Wu Weishe Zhang Weishe Zhang |
| author_facet | Jingrui Huang Xiaowen Zhang Lijuan Liu Si Duan Chenlin Pei Yanhua Zhao Rong Liu Weinan Wang Yu Jian Yuelan Liu Hui Liu Xinhua Wu Weishe Zhang Weishe Zhang |
| author_sort | Jingrui Huang |
| collection | DOAJ |
| description | Objective: To evaluate the use of tourniquet and forceps to reduce bleeding during surgical treatment of severe placenta accreta spectrum (placenta increta and placenta percreta).Methods: A tourniquet was used in the lower part of the uterus during surgical treatment of severe placenta accreta spectrum. Severe placenta accreta spectrum was classified into two types according to the relative position of the placenta and tourniquet during surgery: upper-tourniquet type, in which the entire placenta was above the tourniquet, and lower-tourniquet type, in which part or all of the placenta was below the tourniquet. The surgical effects of the two types were retrospectively compared. We then added forceps to the lower-tourniquet group to achieve further bleeding reduction. Finally, the surgical effects of the two types were prospectively compared.Results: During the retrospective phase, patients in the lower-tourniquet group experienced more severe symptoms than did patients in the upper-tourniquet group, based on mean intraoperative blood loss (upper-tourniquet group 787.5 ml, lower-tourniquet group 1434.4 ml) intensive care unit admission rate (upper-tourniquet group 1.0%, lower-tourniquet group 33.3%), and length of hospital stay (upper-tourniquet group 10.2d, lower-tourniquet group 12.1d). During the prospective phase, after introduction of the revised surgical method involving forceps (in the lower-tourniquet group), the lower-tourniquet group exhibited improvements in the above indicators (intraoperative average blood loss 722.9 ml, intensive care unit admission rate 4.3%, hospital stays 9.0d). No increase in the rate of complications was observed.Conclusion: The relative positions of the placenta and tourniquet may influence the perioperative risk of severe placenta accreta spectrum. The method using a tourniquet (and forceps if necessary) can improve the surgical effect in cases of severe placenta accreta spectrum. |
| first_indexed | 2024-12-20T02:53:49Z |
| format | Article |
| id | doaj.art-693fc5d0dff04868945e942c253c3f4c |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-20T02:53:49Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-693fc5d0dff04868945e942c253c3f4c2022-12-21T19:55:58ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-10-01810.3389/fmed.2021.557678557678Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular ControlJingrui Huang0Xiaowen Zhang1Lijuan Liu2Si Duan3Chenlin Pei4Yanhua Zhao5Rong Liu6Weinan Wang7Yu Jian8Yuelan Liu9Hui Liu10Xinhua Wu11Weishe Zhang12Weishe Zhang13Department of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Radiology, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaDepartment of Obstetrics, Xiangya Hospital Central South University, Changsha, ChinaHunan Engineering Research Center of Early Life Development and Disease Prevention, Changsha, ChinaObjective: To evaluate the use of tourniquet and forceps to reduce bleeding during surgical treatment of severe placenta accreta spectrum (placenta increta and placenta percreta).Methods: A tourniquet was used in the lower part of the uterus during surgical treatment of severe placenta accreta spectrum. Severe placenta accreta spectrum was classified into two types according to the relative position of the placenta and tourniquet during surgery: upper-tourniquet type, in which the entire placenta was above the tourniquet, and lower-tourniquet type, in which part or all of the placenta was below the tourniquet. The surgical effects of the two types were retrospectively compared. We then added forceps to the lower-tourniquet group to achieve further bleeding reduction. Finally, the surgical effects of the two types were prospectively compared.Results: During the retrospective phase, patients in the lower-tourniquet group experienced more severe symptoms than did patients in the upper-tourniquet group, based on mean intraoperative blood loss (upper-tourniquet group 787.5 ml, lower-tourniquet group 1434.4 ml) intensive care unit admission rate (upper-tourniquet group 1.0%, lower-tourniquet group 33.3%), and length of hospital stay (upper-tourniquet group 10.2d, lower-tourniquet group 12.1d). During the prospective phase, after introduction of the revised surgical method involving forceps (in the lower-tourniquet group), the lower-tourniquet group exhibited improvements in the above indicators (intraoperative average blood loss 722.9 ml, intensive care unit admission rate 4.3%, hospital stays 9.0d). No increase in the rate of complications was observed.Conclusion: The relative positions of the placenta and tourniquet may influence the perioperative risk of severe placenta accreta spectrum. The method using a tourniquet (and forceps if necessary) can improve the surgical effect in cases of severe placenta accreta spectrum.https://www.frontiersin.org/articles/10.3389/fmed.2021.557678/fullclassificationplacenta accreta spectrumpregnancy outcomecesarean sectionsurgery |
| spellingShingle | Jingrui Huang Xiaowen Zhang Lijuan Liu Si Duan Chenlin Pei Yanhua Zhao Rong Liu Weinan Wang Yu Jian Yuelan Liu Hui Liu Xinhua Wu Weishe Zhang Weishe Zhang Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular Control Frontiers in Medicine classification placenta accreta spectrum pregnancy outcome cesarean section surgery |
| title | Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular Control |
| title_full | Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular Control |
| title_fullStr | Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular Control |
| title_full_unstemmed | Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular Control |
| title_short | Placenta Accreta Spectrum Outcomes Using Tourniquet and Forceps for Vascular Control |
| title_sort | placenta accreta spectrum outcomes using tourniquet and forceps for vascular control |
| topic | classification placenta accreta spectrum pregnancy outcome cesarean section surgery |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.557678/full |
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