Comparative evaluation of the efficiency of surgical hemostatic techniques during organ-sparing delivery in patients with placenta increta
Objective. To assess the results of using various surgical hemostatic techniques (internal iliac artery (IIA) ligation, temporary common iliac artery (CIA) occlusion, and complex hemostasis compression) during cesarean section in patients with placenta increta. Subject and methods. For comparative evaluation of the efficiency of the proposed techniques, 3 groups of patients with placenta increta, who had undergone one of the surgical hemostatic techniques during caesarean section, were identified. IIA ligation was used in Group 1 (n=15) and temporary CIA was done in Group 2 (n=18). Group 3 (n=21) underwent complex hemostasis compression including the application of bilateral tourniquets to the base of the broad ligaments and cervico-isthmus region of the uterus, which had been complemented by controlled uterine balloon tamponade. Results. Complex hemostasis compression is the most effective technique, in which the average blood loss was 1295±520.3 ml (p=0.0045), a blood loss of over 2000ml occurred in 2 (9.5%) cases (p=0.0411). In Groups 1 and 2, blood losses were 2440±1215 and 2186±1353 ml, respectively. Massive blood loss over 2000 ml was observed in more than 50% when blood circulation was stopped along both the bed of CIA and IIA. Length of surgery, changes in hemoglobin levels, frequency of hysterectomies, and duration of hospital stay after delivery were not significantly different. Conclusion. Complex hemostasis compression is the most effective technique to reduce blood loss and the most effective organ-sparing method during operative delivery in patients with placenta increta.