Background: An optimal international standard for PAS surgery is not yet available, and the establishment of a suitable surgical method is an important focus of in PAS management.
Objective: To assess the efficacy and safety of tourniquet uses for conservative approach in the management of placenta accerta spectrum.
Patients and Methods: 40 pregnant women who underwent conservative management of placenta accrete at Kasr El-Aini hospital (Obstetrics and gynecology department - Faculty of medicine - Cairo university) were included and were divided according to the use of tourniquet into 2 equal groups: Study group (tourniquet group): consists of 20 women for whom tourniquet was used in the lower part of the uterus during surgical treatment of placenta accreta spectrum.Control group (no tourniquet group): consists of 20 women for whom no tourniquet was used.
Pregnant females with previous CS deliveries (at least 1).
Patients with ultrasound criteria of placenta accerta spectrum.
Patients desiring fertility (uterine conservation).
Patients with gestational age that completed 34 weeks (or more) confirmed by the 1st day of the LMP or 1st trimester ultrasound scan.
Maternal age above 40 years.
Chronic medical disorders (e.g., cardiac, renal, DM and hepatic diseases).
Patients presented with severe antepartum hemorrhage (unstable vital signs).
Patients requested radical management (caesarean hysterectomy).
Parallel
Uterovesical tourniquet before uterine devascularization steps
Procedure/SurgeryInsertion of a Foley catheter tourniquet through broad ligament apertures \& tightening it immediately before hysterotomy in cases of conservative management of placenta accreta spectrum
Conventional conservative surgery
Procedure/SurgeryConventional conservative surgery
Intraoperative quantified blood loss
Quantified blood loss estimate with the tourniquet
amount of blood and blood product transfusion
amount of blood and blood product transfusion
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