Management of Neuraxial Anaesthesia for Emergent Caesarean Section for Placenta Previa

Abstract

Plasenta akreta, inkreta veya perkrata gibi plasenta yapışma anomalileri ciddi postpartum kanama riski nedeniyle morbidite ve mortalite artışına neden olabilirler. Otuz altı haftalık multipar gebede plasenta previaya bağlı vajinal kanama nedeniyle acil sezaryen için uygulanan spinal anestezi yönetimi ve cerrahi yaklaşımı literatür eşliğinde tartışarak sunmayı amaçladık. Spinal anestezi için intratekal olarak 12 mg hiperbarik bupivakain+10 µg fentanil+ 150 µg morfin verildi. Göbek kordonu klemplendikten sonra oksitosin, metilergonovin ve traneksamik asit verildi. Plasentaya zarar vermekten kaçınmak için uterusa yapılan vertikal kesiyle bebek makat doğurtuldu. Plasentaya dokunmadan yerinde bıraka-rak subtotal histerektomi yapıldı.Yaklaşık 40 dk. süren girişimde 2 ünite eritrosit süspansiyonu verildi. Hasta postoperatif 4. günde sorunsuz taburcu edildi. Sonuç olarak sezaryenle doğum sırasında plasenta inkreta ile karşılaşılan olguda genel anesteziye geçilmeden tek doz spinal anestezi, histerektomi ameliyatının sonuna dek başarıyla devam ettirildi.Anahtar kelimeler: Plasenta yapışma anomalisi, plasenta previa, plasenta inkreta, sezaryen, spinal anestezi Abnormal placental attachments, such as placenta accreta, increta or percrata, can result in increased morbidity and mortality because of the risk of severe postpartum haemorrhage. We aimed to present the management of spinal anaesthesia and surgical approach for emergent caesarean section because of vaginal bleeding in a multiparous pregnant woman with placenta previa at 36 weeks' gestation. Hyperbaric bupivacaine 12 mg, fentanyl 10 µg and morphine 150 µg were intrathecally administered for spinal anaesthesia. Oxytocin, methyl ergonovin and tranexamic acid were administered after umbilical cord clamping. Breech delivery of the baby was provided by a vertical incision to the uterus for avoiding placental harm. Subtotal hysterectomy was performed leaving the placenta in situ. Two units of red blood cells were transfused during the operation, lasting approximately 40 min. The patient was uneventfully discharged on the postoperative fourth day. In conclusion, a single-shot spinal anaesthesia was successfully maintained without conversion to general anaesthesia until the end of the hysterectomy in the patient in whom placenta increta was observed during caesarean delivery.

Retrospective Evaluation of Anesthetic Management in Cesarean Sections of Pregnant Women with Placental Anomaly

“…In addition, bleeding and increased surgical manipulation prolong the operating time, and these are other factors causing discomfort in an awake patient [13,18,19]. Nevertheless, in a questionnaire applied to obstetric anesthetists, it was reported that 65% applied SA to PP cases where complications are not expected, and GA was preferred by 69.2% in cases with suspected PA and by 96.2% in cases diagnosed with PA. Gunaydın et al have reported successful management with SA in patients with PP and PA [20]. In the current study, SA was applied to PP cases where fewer complications were expected and GA was preferred for the other PP cases and all but one of the PA cases.…”