The use of the double uterine segment tourniquet in obstetric hysterectomy for bleeding control in patients with placenta accreta spectrum

Abstract

Placenta accreta spectrum (PAS) is defined as an abnormal trophoblast invasion into the myometrium, and sometimes up to or beyond the serosa. The pathogenesis is mostly due to placental implantation at an area of defective decidualization caused by pre-existing damage to the endometrial-myometrial interface. 1,2 Depending on the degree of invasion, PAS can be classified as placenta accreta when anchoring placental villi attach to the myometrium (rather than decidua), placenta increta when anchoring placental villi penetrate into the myometrium, and placenta percreta when anchoring placental

Modified one‐step conservative uterine surgery (MOSCUS) versus cesarean hysterectomy in the management of placenta accreta spectrum: A single‐center retrospective analysis based on 619 Vietnamese pregnant women

“…In the present study, besides vascular control regarding the abnormal neovascularity on the vesical surface, placental bed suture, and bilateral uterine artery ligation, a tourniquet was used in the lower part of the uterus (cervico‐isthmic segment) to achieve reduction of estimated blood loss during hemostatic procedures. Some studies have also reported the benefit of using single or double uterine segment tourniquets for vascular control with highly effective results in cases of PAS 48,49 . In particular, the transverse B‐Lynch suture was added to compress the lower uterine segment and reduce blood flow via the upper and lower branches of the bilateral uterine arteries.…”

“…Some studies have also reported the benefit of using single or double uterine segment tourniquets for vascular control with highly effective results in cases of PAS. 48,49 In particular, the transverse B-Lynch suture was added to compress the lower uterine segment and reduce blood flow via the upper and lower branches of the bilateral uterine arteries. The additional uterine compression suture is the most important aspect of the MOSCUS method compared with previous studies.…”

Response: Double tourniquets for cesarean hysterectomy for placenta accreta spectrum—Surgical technique explanation

“…We previously reported that the use of double uterine tourniquets, compared with non‐use, significantly reduced surgical blood loss during hysterectomy for placenta accreta spectrum (PAS) 1 . Some technical concerns arose following the publication of this paper, which we will address here.…”

Letter to the editor: Double tourniquets in cesarean hysterectomy for placenta accreta spectrum—Some technical questions

“…Reyther et al 1 showed that the use of double uterine tourniquets, compared with non‐use, significantly reduced surgical blood loss during hysterectomy for placenta accreta spectrum (PAS).…”

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Reyther et al 1 showed that the use of double uterine tourniquets, compared with non-use, significantly reduced surgical blood loss during hysterectomy for placenta accreta spectrum (PAS).The hemostatic mechanism of a tourniquet is simple in an organ/area of one-way arterial and venous circulation (Figure 1a). The tourniquet blocks/reduces the arterial inflow, thus working toward hemostasis, whereas it blocks venous outflow, causing venous congestion, which works against hemostasis.

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