<p>Postpartum hemorrhage remains the leading cause of maternal mortality and morbidity worldwide, happens more in developing countries with an estimated mortality rate of 140,000 per year or one maternal death every four minutes</p><p>To understand anesthesia management at postpartum et causa atonic uteri bleeding outside Dr. Moewardi hospital</p><p>In this case reported 25 years old patient was admitted to the emergency room at Dr. Moewardi Hospital Surakarta, on the 28/11/2019 at 15.30 WIB, sent by Waras Hospital Wiris Boyolali. On examination found the patient in a state of weakness, apathy awareness and blood pressure 90/60, heart rate 130, respiration rate 22, conjunctival anemic and palpable contractions of soft uterine contractions. The patient's condition is in accordance with the manifestation of grade III blood loss. The anesthesiology diagnosis is a 25-year-old woman with Postpartum hemorrhage et causa Atonic Bleeding of Uterine on P3A0H3 post SCTP Outside Dr. Moewardi Hospital + Hypovolemic Shock pro Emergency Laparotomy until Total Abdominal Hysterectomy with Physical Status ASA IVE Plan with RSI general anesthesia Control.</p><p>Intraoperative Management of anesthesia uses RSI's general anesthesia technique to control hemodynamics and uses anesthesia drugs that do not worsen the patient's condition. At the time of surgery, we did the transfusion because there was a significant amount of bleeding during the procedure and was categorized as Class IV bleeding.</p><p>Anesthesia care of patients with postpartum hemorrhage extends from the antenatal period to the postpartum period. Optimal postpartum hemorrhage management occurs when nurses, obstetricians and anesthesiologists recognize early the potential for excessive bleeding and trigger a 'major obstetric hemorrhage protocol' that describes specific tasks for each team player and the algorithm that must be followed according to etiology, circumstances and time during labor.</p>

Perdarahan postpartum merupakan salah satu penyebab utama kematian ibu selain penyakit kardiovaskuler. Diantara penyebab perdarahan post partum adalah plasenta akreta dimana insidennya semakin meningkat dari tahun ke tahun seiring dengan peningkatan jumlah persalinan dengan seksio sesarea. Kami laporkan dua kasus ibu hamil dengan plasenta akreta yang direncanakan tindakan seksio sesarea emergency yang dikelola dengan general anesthesia rapid sequence induction. Kasus pertama, perempuan berusia 31 tahun G3P1A1 usia kehamilan 36–37 minggu dalam persalinan, perdarahan antepartum ec plasenta previa totalis, plasenta akreta dengan hemodinamik stabil. Intraoperatif, perdarahan sekitar 7000 cc, dan diberikan transfusi 8 unit PRC, 4 unit WB, 4 unit FFP, dan 4 unit Tc. Pascaoperasi pasien dirawat di ICU, dan komplikasi yang terjadi produk drain abdomen sekitar 1900 cc bercampur darah. tidak ada komplikasi mayor lainnya, pasien pindah ruang rawat inap pada hari keempat pascaoperasi. Kasus kedua, perempuan berusia 40 tahun G3P2A0 usia kehamilan 37–38 minggu dalam persalinan, perdarahan antepartum ec plasenta previa totalis, plasenta akreta dengan hemodinamik stabil. Intraoperatif, perdarahan sekitar 9000 cc, dan dilakukan transfusi 8 unit PRC, 8 unit WB, 4 unit FFP, dan 4 unit Tc. Pascaoperasi pasien dirawat di ICU, dan. tidak ada komplikasi signifikan terjadi. Hari kedua pascaoperasi pasien pindah ke ruang rawat inap. Case Series: Anesthesia Management in Pregnant Woman with Placenta Accreta Planned for Caesarean Section Abstract Postpartum hemorrhage is one of the leading causes of maternal morbidity besides cardiovascular disease. Among the causes of postpartum hemorrhage is placenta accreta, where the incidence increases from year to year along with the increase in the number of cesarean delivery. We report two cases of pregnant women with placenta accreta planned for emergency cesarean section managed with general anesthesia rapid sequence induction. The first case, 31-year-old woman G3P1A1 36–37 weeks of gestation in labor, antepartum hemorrhage ec placenta previa totalis, placenta accreta with hemodynamically stable. During procedure, blood loss about 7000 cc, and given transfusion of 8 units of PRC, 4 units of WB, 4 units of FFP, and 4 units of Tc. In the end of procedure, the patient was transferred to intensive care unit, and complications that occurred around 1900 cc of abdominal drain product mixed with blood. After that, there were no other major complications, then the patient moved the ward on the fourth day. The second case, a 40-year-old woman G3P2A0 37–38 weeks of gestation in labor, antepartum hemorrhage ec placenta previa totalis, placenta accreta with hemodynamically stable. During procedure, blood loss about 9000 cc, and given transfusion of 8 units of PRC, 8 units of WB, 4 units of FFP, and 4 units of Tc. In the end of procedure, the patient was transferred to intensive care unit, and no significant complications happen. The second day after surgery the patient moved to the ward.