RESUMO
INTRODUCTION: Hemorrhage from a partially or fully detached placenta with an advanced abdominal pregnancy can be profuse and catastrophic. The general approach to placental management is removal of "all or nothing." In the event of acute hemorrhage, attempts to achieve hemostasis quickly are critical. We have found a Foley catheter tourniquet to be useful to control placental hemorrhage or as a temporary tourniquet applied around structures surrounding the implantation site to aid placental removal. We report use of the technique on 4 occasions with good surgical outcomes. CASE PRESENTATION: We report the case of a 33-year-old primigravid woman admitted at term with ultrasound diagnosis of breech presentation and placenta previa grade 4. Her preoperative clinical assessment, however, raised suspicion of an abdominal pregnancy. At laparotomy, a live female infant was delivered from the extra-uterine gestation sac, weighing 3,640 g and with Apgar scores of 7 and 6 at 1 and 5 min, respectively. Following delivery, there was profuse bleeding from the partially detached distal portion of the placenta that derived a rich blood supply from the poorly accessible posterior pelvic wall. We applied a novel, simple, and effective surgical technique for minimizing blood loss from the partially detached placenta using a Foley's catheter tourniquet that was applied between the detached and still attached parts of the placenta. The tourniquet was left in situ and removed at laparotomy 4 days later. The placenta was not removed. The mother and baby did well postoperatively and were discharged after 10 and 21 days, respectively, in good condition. The surgical technique was used in 3 additional cases with good clinical outcomes. DISCUSSION: Use of a Foley catheter as an intraoperative tourniquet has become accepted as a useful technique in obstetric and gynecological surgery. We describe a simple life-saving technique of applying a Foley tourniquet across a partially detached placenta following an advanced extra-uterine pregnancy to control acute hemorrhage. CONCLUSION: We recommend that surgeons keep in mind the option of intraoperative tourniquets when faced with uncontrollable bleeding as a short-term or medium-term temporizing measure.
