[Cesarean section for case with preoperatively-suspected placenta accrete followed by hysterectomy due to uncontrollable massive bleeding].
A 42-yr-old pregnant woman highly suspicious of the placenta accreta was scheduled for cesarean section (c-section) under general anesthesia. She had received emergency c-section for the placenta previa at 36 years of age and three episodes of intrauterine curettage for spontaneous abortion. While the possibility of placenta accreta was pointed out and the risks accompanying with it were explained at the 7th week of pregnancy, she insisted on having a baby. C-section was intended at around the 30th week of pregnancy and 1,200 ml of autologus blood was stored for the predictable massive bleeding. Bilateral embolization of the internal iliac artery was also planned. The baby was delivered uneventfully. However, the adherence of the placenta was so tight that the placenta could not be separated from the uterine wall. The arterial embolization immediately after the delivery did not work as effectively as to control massive bleeding. It took about 1 hour to control the massive bleeding of up to 9000 ml by difficult hysterectomy. Since we had prepared for such a situation, we could well catch up with the massive bleeding. The mother and baby were discharged well from the hospital 29th day after the c-section.
Kono
Yasuo
Y
Department of Anesthesiology, Kurume University School of Medicine, Kurume 830-0011.
Sawada
Maiko
M
Kano
Tatsuhiko
T
D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D001803:Blood Transfusion; D002585:Cesarean Section; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007044:Hysterectomy; D019990:Perioperative Care; D010921:Placenta Accreta; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000628:therapy; D011256:Pregnancy Outcome; D014592:Uterine Hemorrhage / Q000209:etiology* / Q000628:therapy