A Novel Tourniquet Technic for Massive PPH

Study Overview
=================
Brief Summary
-----------------
In this study, the investigators aimed to find out the effect of a novel tourniquet technique, in cases of excessive bleeding during cesarean delivery.

Detailed Description
-----------------
In this retrospective comparative study, the investigators compared the peripartum features of patients who experienced profuse postpartum bleeding during C/S and this novel atraumatic tourniquet technique was used and not used. In this technique; the uterus is exteriorized following the delivery of the baby and before the removal of the placenta to be able to apply the tourniquet technique. In this technique it is not obligatory to push the bladder before the procedure. Afterwards, the surgeon and the assistant palpate the ureters with both hands in the two sheaths of broad ligament and try to hear a 'click' sound which comes from ureter sliding out between both fingers. After confirming that the ureters are not in the surgical site, an atraumatic vascular DeBakey clamp is applied widely including both the infundibulopelvic ligament and uterine arteries. Thus, two-sided blood supply of the uterus is reduced significantly and this gives the surgeon some time, for planning further surgical procedures and also serves a minimal bloody surgical site. If the avascular state of the surgical site is needed for a prolonged time, for instance while preparing for a blood transfusion or while waiting until an experienced surgeon is available, the clamps were opened and closed intermittently for a maximum of 10 minutes, as to sustain the blood supply of the ovaries and the uterus.

Official Title
-----------------
A Novel Atraumatic Tourniquet Technique in Cases of Excessive Bleeding During Cesarean Section

Conditions
-----------------
Postpartum Hemorrhage

Intervention / Treatment
-----------------
* Procedure: tourniquet(+)
* Procedure: tourniquet(-)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: The women who experienced profuse postpartum haemorrhage during cesarean section Exclusion Criteria: none defined

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 35 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| tourniquet (+)<br>The cases in which the tourniquet technique is used | Procedure: tourniquet(+)<br>* A novel atraumatic tourniquet technique, applied via placing a vascular clamp widely on both the infundibulopelvic ligament and uterine arteries.<br>|
| tourniquet(-)<br>The cases in which the tourniquet technique is not used | Procedure: tourniquet(-)<br> <br> * Other names: The tourniquet was not used;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hemoglobin values | The differences in hemoglobin values just before the surgery and immediately after the surgery | 1 hour | 
| red blood cell transfusion | the amount of packed red blood cells, required for haemodynamic stability in the first 24 hour. | 24 hours | 
| fresh frozen plasma transfusion | the amount of packed fresh frozen plasma, required for haemodynamic stability in the first 24 hour. | 24 hours |