Efficacy of the tourniquet hemostasis combined with vaginal balloon tamponade using a Zhukovsky vaginal catheter during delivery in placenta accreta spectrum


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Abstract

Objective: To evaluate the efficacy of distal tourniquet hemostasis combined with vaginal balloon tamponade using a Zhukovsky vaginal catheter during delivery of pregnant women with placenta accreta spectrum to reduce intraoperative blood loss. Materials and methods: A prospective observational study enrolled 164 pregnant women with histologically confirmed placenta accreta spectrum and underwent distal tourniquet hemostasis. The patients were divided into Group 1 (study group, n=133) and Group 2 (control group, n=31) who had and did not have vaginal balloon tamponade in addition to distal tourniquet hemostasis, respectively. Results: All patients in Group 1 (n=133) underwent organ-sparing surgery. The median blood loss was 959 (699; 1651) mL in Group 1 and 1549 (899.5; 2098) mL in Group 2. Patients in Group 1 did not require a transfusion of donor blood components. The volume of autotransfusion in the study group was 208 ml versus 485 ml in the control group. Conclusions: Distal tourniquet hemostasis combined with vaginal balloon tamponade using a Zhukovsky vaginal catheter was highly effective in surgical delivery in patients with placenta accreta spectrum and allowed significant reduction in intraoperative blood loss. The findings of the study give reason to recommend the use of this technique in daily clinical practice to guide the delivery strategy in pregnant women with this pathology.

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About the authors

Ilyas A. Kulikov

Vidnovsky Perinatal Center

Email: aesculap@inbox.ru
PhD, Head of the Department of Pregnancy Pathology

Roman G. Shmakov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: r_shmakov@oparina4.ru
Dr. Med. Sci., Professor, Director of the Institute of Obstetrics

Tamara N. Belousova

Vidnovsky Perinatal Center

Email: beltamara1@mail.ru
PhD, Head Physician

Elena N. Plakhotina

Vidnovsky Perinatal Center

Email: enp2004@inbox.ru
Dr. Med. Sci., Head of the Department of Anesthesiology and Intensive Care

Natalia V. Nizyaeva

Avtsyn Research Institute of Human Morphology

Email: niziaeva@gmail.com
Dr. Med. Sci, Head of the Laboratory of Pathology

Irina A. Geilis

Vidnovsky Perinatal Center

Email: dr.irina7l@mail.ru
Head of the Department of Antenatal Fetal Protection and Perinatal Diagnostics

Dzhangar D. Iskakov

Vidnovsky Perinatal Center

Email: iskakov.jangar@yandex.ru
Physician at the Department of Pregnancy Pathology

Ekaterina R. Milyutina

Vidnovsky Perinatal Center

Email: milyutina.kate@mail.ru
Physician at the Department of Pregnancy Pathology

Elena A. Vdovichenko

Vidnovsky Perinatal Center

Email: e.vdovichenko.00@mail.ru
Physician at the Department of Pregnancy Pathology

Denis V. Prochakovsky

Vidnovsky Perinatal Center

Anesthesiologist-Intensivist at the Department of Anesthesiology and Resuscitation

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