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Successful Management of Placenta Percreta with Preservation of Uterus: A Case Report
Abstract Number: SAT-80
Abstract Type: Case Report/Case Series
Backgroud: Morbidly adherent placenta (MAP) can lead to catastrophic maternal hemorrhage and hysterctomy. In China, the increasing incidence of MAP has been attributed largely to the high rate of cesarean delivery during the recent years. The recently adopted “two children” family planning policy obviously will bring MAP to the frontline of maternal care. It has become a common issue and challenge for obstetric anesthesiologists in China. We present a cesarean delivery case with placenta percreta that was successfully managed by multidisciplinary team.
Case report: A 28-year-old G4P1 woman was transferred to our hospital because of vaginal bleeding and moderate anemia at 36-week gestation. She had history of one prior cesarean delivery and two prior D&Es. Magnetic resonance imaging and transabdominal ultrasound indicated central type of placental previa, placenta percreta and suspected invasion of bladder. However, the patient expressed strong preference for preservation of uterus. A multi-disciplinary team consisting of obstetricians, anesthesiologists, gynecologists, vascular surgeons, urologists, blood bank and NICU staff, and radiologists was assembled. After abdominal aorta balloon catheterization, the patient was transferred to OR for an elective cesarean delivery. Central line and radial artery catheterization were placed to monitor physiological and hemodynamic parameters. Epidural anesthesia was administered initially. With the consideration of limited RBC transfusion rate, RBC was initiated just before the abdominal incision. Intraoperatively, a large area of placenta in the size of 10cm x 12cm was firmly attached to lower uterine segment. General anesthesia was induced and aorta balloon was inflated to control bleeding after the delivery of the fetus. Intrauterine gauze tamponade and additional bilateral uterine artery embolization was placed. Cardiac hemodynamic parameter-guided volume therapy and vasoactive agent(s) were used to maintain stable circulation. Routine blood test and coagulation function test were conducted to direct blood transfusion. The total EBL was 4000ml. Epidural analgesia was used for pain management postoperatively. There were no intraoperative or postoperative complications.
Conclusion: Perfect evaluation and full preparation with a multi-disciplinary team is necessary for management of placenta percreta. Reliable invasive monitoring and bleeding preventive measures are preferred to achieve better maternal outcome.