Combined spinal-epidural and general anaesthesia for cesarean section in pregnant patients with placentary anomalies – two case reports

Abstract

Combined spinal-epidural and general anaesthesia for cesarean section in pregnant patients with placentary anomalies -two case reportsPlacentary anomalies can be associated with massive blood loss at delivery and with high maternal mortality.Placenta previa (PP) is the insertion of the placenta in the lower segment of the uterus. Placenta accreta (PA) is defined as an abnormal attachment of the placenta to the myometrium.Prenatal diagnosis allows a reduction of maternal morbimortality, as it makes possible to plan the surgical approach and antecipate hemorrhagic control methodology.We present two pregnant women,ASA II, admitted for elective c-sections due to placental abnormalities.We performed combined neuroaxial anaesthesia to enable the setting of double J catheter and the iliac artery ballon catheter, followed by general anesthesia to perform cesarean, protecting the fetus from the deleterious effects of prolonged general anaesthesia.Induction of general anaesthesia was motivated by the predictable complexity of the surgical intervention.The epidural catheter was used to administer post-operative analgesia. Case 1 40 years-old, G3P2, diagnosis of placenta previa Previous history: Tw o c-sections (fetus pelvic presentation) Preoperative tests: Hg10.2 g/dL, platelets 167 000 / mm3 blood. No changes in coagulation tests (aPTT, TP, fibrinogen)Case 235-year-old, G2P1, diagnosed with total central placenta previa with accretism on the uterine scar.