The Efficacy and Surgical Outcomes of Cervical Foley Catheter Tourniquet in Placenta Accreta Spectrum Disorders.

Objective: We aimed to evaluate the impact of the cervical Foley catheter tourniquet on perioperative surgical interventions, transfusion requirements, and maternal-neonatal outcomes in patients with placenta accreta spectrum (PAS). Materials and Methods: In this single-center retrospective cohort study, 265 patients with confirmed PAS were categorized into a tourniquet group (n = 87, cervical Foley catheter tourniquet applied after fetal delivery) and a control group (n = 178, standard hemostasis) following an institutional protocol update. Perioperative surgical interventions, hematologic parameters, transfusion needs, and maternal-neonatal outcomes were compared. Results: Baseline characteristics were generally comparable between groups. The decrease in hemoglobin (ΔHb) was significantly smaller in the tourniquet group than in controls (1.51 ± 1.11 vs. 1.75 ± 1.57 g/dL; p = 0.045). The tourniquet group had significantly fewer maternal ICU admissions (4.6% vs. 12.4%; p = 0.049); however, ICU length of stay among admitted patients did not differ significantly between groups (median 1.0 vs. 1.0 days; p = 0.585). The peripartum hysterectomy rate was lower in the tourniquet group (8.0% vs. 16.3%), although this difference did not reach conventional statistical significance (p = 0.085). Operative time was longer in the tourniquet group (105.0 vs. 60.0 min; p < 0.001). No maternal deaths occurred in either cohort. Conclusions: The cervical Foley catheter tourniquet is a feasible and low-cost surgical adjunct that was associated with a smaller perioperative decline in hemoglobin and lower maternal ICU admission rates, alongside higher rates of uterine-preserving procedures. However, because actual blood loss was not directly quantified and transfusion frequency remained high, its true independent effect on intraoperative blood loss and total transfusion requirements remains uncertain.