Anaesthesia for Caesarean hysterectomy in a patient with a preoperative diagnosis of placenta percreta with invasion of the urinary bladder

Abstract

Purpose: Placenta Percreta with invasion of the urinary blader is a rare condition, which carries a high morbidity and

Central placenta previa with placenta percreta partially invading bladder: a case report

“…8,9 The patient in this case report had no symptoms as discussed earlier except for ployhydramnios on presentation but later she developed antepartum hemorrhage and gross hematuria.…”

“…Hunter T, Kleiman, set a routine protocol: cross matched for at least 10 units of packed red blood cells, 4 unit of fresh frozen plasma and 10 packs of platelets, before opting this type of cases due to increased chances of bleeding during the delivery. 8 Autologous blood salvage device have proved safe and the use of these device may be a valuable adjunct during the surgery, 12 in a case where the blood products are unavailable or shortage of blood products. Gallus et al states that autologus blood salvage is quick, inexpensive and no cross matching is required.…”

“…Several other techniques to decrease blood loss and bleeding controls are also described in literature such as manual compression or cross clamping the aorta, oxytocin administration, hemodilution, bilateral iliac artery occlusion/embolization and Factor VIIa administration etc. 1,2,8,13 Pneumatic compression stocking should be placed pre operatively and should be maintained until the patients is fully ambulatory. The patients is this case reports received 3800 ml red blood cells, 2200 ml fresh frozen plasma and 20 units cryoprecipitate , antibiotics and vigorous fluid infusions because the patient underwent hemorrhagic shock.…”

Multidisciplinary management of placenta percreta complicated by embolic phenomena

“…If diagnosed early a multidisciplinary approach allows safe and successful delivery. 6,8 Hunter et al reported involvement of urology, vascular surgery, critical care and anesthesiology for a cesarean delivery and partial bladder resection in a patient with placenta percreta. 8 Shih et al prevented massive blood loss altogether by placing temporary balloon occlusion catheters in the common iliac arteries before cesarean delivery, resulting in a total blood loss of 800 mL.…”

“…6,8 Hunter et al reported involvement of urology, vascular surgery, critical care and anesthesiology for a cesarean delivery and partial bladder resection in a patient with placenta percreta. 8 Shih et al prevented massive blood loss altogether by placing temporary balloon occlusion catheters in the common iliac arteries before cesarean delivery, resulting in a total blood loss of 800 mL. 6 The present case report involved placement of internal iliac artery balloons and subsequent embolization of the uterine arteries by an interventional radiologist.…”