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Management of a severe case of placenta percreta.
Abstract Number: F2D-7
Abstract Type: Case Report/Case Series
Background: Placenta percreta is associated with significant maternal morbidity and mortality. Here we present successful intraoperative resuscitation of a 36 year old patient with placenta percreta invading into the urinary bladder.
Case Presentation: The patient was a 36 year old female with past medical history significant for anemia and past surgical history significant for a cesarean section. A repeat cesarean section was scheduled for possible placenta accreta seen on pelvic MRI. Intraoperatively it was discovered that the placenta had invaded through the uterine wall and into the urinary bladder. During the course of the cesarean section, hysterectomy, and urinary bladder repair 22 units of PRBC, 22 units of FFP, 12 units of cryoprecipitate, 13 units of pooled platelets, 4,170ml of cell saver blood and 11,400 ml of crystalloid were infused. The patient was transferred to the surgical intensive care unit without any vasoactive medications being infused and with the hemorrhage-related coagulopathy resolved. She required no vasoactive medications or blood products postoperatively. Also, the cell saver device was used to "wash" all PRBC units that were transfused. This decreased the potassium in each unit and assisted in keeping the patient's potassium within the normal range.
Conclusion: In patients with placenta percreta using the massive transfusion protocol can provide guidance for successful resuscitation while also correcting hemorrhage-related coagulopathy.