Caesarean delivery using general anesthesia in pregnant woman with placenta accreta accompanied with massive hemorrhage
Caesarean delivery in placenta accreta
DOI:
https://doi.org/10.59747/smjidisurabaya.v3i1.98Keywords:
General anesthesia, placenta accreta, caesarean delivery, hypovolemic shockAbstract
Background: Placenta accreta spectrum (PAS) is a disorder of placental implantation that causes peripartum bleeding and is the main cause of maternal death. PAS has a high risk of intraoperative bleeding therefore blood preparation and transfusion are essential. Objective: To describe the medical management of obstetric emergency of caesarean surgery with hypovolemic shock underwent general anaesthesia in patient with placenta accreta. Case: A woman, 36 years old, diagnosed with G4P3A0, gestational age 27-28 weeks with placenta accreta with blood pressure of 63/43, heart rate of 135, respiratory rate (RR) of 30, SpO2 97% O2 non rebreathing oxygen mask (NRBM) 10 lpm, experiencing vaginal bleeding since 6 days, was planned for caesarean delivery with emergency surgery due to hypovolemic shock as the result of massive hemorrhage, anemia, leukopenia, and hyponatremia. PAS diagnosis was determined after ultrasound imaging. Operation duration was 3.5 hours, with blood loss of 3,500 ml. After the surgery, she was transferred to the Intensive Care Unit (ICU). General anesthesia was chosen to maintain hemodynamic stability. The medical decision for this case was caesarean hysterectomy with the placenta left in situ after delivery of the foetus. Conclusion: Successful management of placenta accreta with massive bleeding is the result of appropriate perioperative management, good preparation and teamwork.
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