Tourniquet on the low segment of the uterus reduces blood loss in postpartum hemorrhage during hysterectomy for placenta accreta: Old but gold

Objectives

To investigate the feasibility, safety, and efficiency after application of a cervical tourniquet during caesarian hysterectomy owing to placenta accreta.

Study design

It was a monocentric prospective observational study for 3 years. Patients were allocated into two group: Group Tourniquet: (TG) in which a cervical tourniquet was systematically applied during hysterectomy, control group (CG) when the caesarian hysterectomy was performed without.

Results

20 patients in the TG and 23 patients in the CG. Tourniquet application significantly reduced per operative estimated blood loss volume (TG: 530 ± 135 vs 940 ± 120 ml in the CG, p = 0.0074), ΔHB (0.6 [0.3-1.9] vs 2.5[2.5-3.6] g/dl in the CG, p = 0.006) RBC transfusion requirements' (TG: 2 ± 1.7 vs 4.3 ± 2.1 units in the CG, p = 0.046) procedure duration (TG: 98 ± 21 vs 137 ± 33 min in the CG, p = 0.015), clotting disorders (TG: 1 (5%) vs 6 (26,1%) in the CG, p = 0.013) and the incidence of bladder wounds (TG: 1 (5%) vs 5 (21,7%) in the CG, p = 0.048). There was no significant difference regarding ICU transfer rate (TG: 16 (80%) vs 20 (86.9%) in the CG, p = 0.53) or length of stay (TG: 1.4 [2,3] vs 2.3 [1-4] days in the CG, p = 0.615) and digestive wound (TG: 0 vs 2 (8,7%) in the CG, p = 0.641).

Conclusion

In case of a radical management of placenta accreta. A strategy that involves the application of a cervical Tourniquet should be considered as a feasible, safe and above all efficient alternative to prevent blood spoliation.

Indigenous populations in Mexico: medical anthropology in the work of Ruben Lisker in the 1960s

Ruben Lisker's research on the genetic hematological traits of Mexican indigenous populations illustrates the intersection of international health policies and the local modernizing nationalism of the Mexican post-revolution period. Lisker's surveys of blood group types, and of G6PD (glucose-6-phosphodehydrogenase) and hemoglobin variants in indigenous populations, incorporated linguistic criteria in the sampling methods, and historical and cultural anthropological accounts in the interpretation of results. In doing so, Lisker heavily relied on the discourse and the infrastructure created by the indigenista program and its institutions. Simultaneously, Lisker's research was thoroughly supported by international and bilateral agencies and programs, including the malaria eradication campaign of the 1950s and 1960s. As a member of the scientific elite he was able to make original contributions to the postwar field of human population genetics. His systematic research illustrates the complex entanglement of local and international contexts that explains the co-construction of global knowledge on human variation after WWII.(1.)