Anesthetic Approach in Case of Placenta Percreata: Case Series
Anestezi Dergisi, cilt.31, ss.158-161, 2023 (Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 31
- Basım Tarihi: 2023
- Dergi Adı: Anestezi Dergisi
- Derginin Tarandığı İndeksler: Scopus, Academic Search Premier, Central & Eastern European Academic Source (CEEAS), EMBASE, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.158-161
- Anahtar Kelimeler: Hemorrhage, hysterectomy, placenta percreta, transfusion
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Placenta percreata is common in line with the increase in cesarean delivery. Diagnosis during pregnancy has vital importance. We present the anesthetic management of eight placenta percreata cases. Case: Eight patients who delivered by cesarean section were operated with the diagnosis of PAS (placenta accreta spectrum disorders). Standard monitoring was applied. Three peripheral venous accesses were placed. Patients are subjected to invasive arterial blood pressure and blood gas monitoring. Central venous catheterization was inserted in two patients. Intraoperative bleeding was monitored. The patients were multiparous between the ages of 26-42. Gestational weeks were between 27-35. Average operative time lasted for 3-4 hours. Two patients had the administration of general anethesia while seven had spinal anesthesia. Diagnosis of placenta percreata were establihed by intraoperative observation. Preoperative haemoglobin(Hb) values were between 9.8-12g/dl. Intraoperative bleeding amount was between 1200-3000cc. Two patients with 2500-3000cc intraoperative bleeding admitted to intensive care unit received 4U packed red blood cell (PRBC), 4U fresh frozen plasma (FFP), fibrinogen, 3000cc fluid. Patient operated under emergency conditios with an Hb value of 7.5g/dl received 2U ORH(-) PRBC.Two patients received steradine infusion. 2U PRBC, 2U FFP, 3500cc fluid were given to two of the patients who bled 1500cc. A patient with 2000cc bleeding received 3U PRBC, 3U FFP, 3500cc fluid. Two patients who received 2000cc fluid had no bleeding into the aspirator. One patient had no blood product transfusion. The other patient received 1U PRBC.All patients received 500cc colloid. After the breech delivery of the baby, 1g transamine was administered to the patients. The hysterectomy was performed leaving the placenta in situ. In 3 cases, the uterus was densely adhered to the bladder, and the surgical plan was lost. Muscular defects occurred in the bladder which was repaired by the urology. In two cases, the intestines were adhered to the posterior surface of the uterus and no problem was encountered. Conclusion: The effect of PAS on pregnancy outcomes is well defined. A multidisciplinary team should discuss potential intraoperative complications and interventions (eg, severe bleeding, blood transfusion, injury or partial resection of bladder and bowel, hysterectomy, risk of postoperative vesicovaginal fistula). Management and delivery in a tertiary care hospital improves outcomes and reduces complication rates.