[Massive hemorrhage during cesarean section for placenta accreta].
A 37-year-old multigravida presented at 37 weeks of gestation with low-lying placenta and highly suspected placenta accreta. The placenta adhered widely to the anterior wall of the uterus. Therefore, a longitudinal incision of the uterine corpus at the thinnest part of the placenta was made during surgery. Concurrent with the incision, rapid and massive hemorrhage occurred. After the delivery of the baby and confirmation of the placental adhesion, the hysterectomy was started promptly. The bladder adhered strongly to the uterus, and was injured during the dissection. The total volume of hemorrhage was estimated to be 24,480 ml (including amniotic fluid and urine). No arterial clamp for hemostasis was used during the procedure. The patient was discharged on the 12th postoperative day with no sequela. The pathological diagnosis was placenta percreta. Placenta accreta is a rare disease with a high mortality rate. The hemorrhage becomes difficult to control in case of injury of placenta accreta. The hysterectomy following cesarean section also becomes complicated. Bladder injury is one of the complications of the cesarean hysterectomy which makes the hemorrhage greader. In conclusion, when placenta accreta is suspected a strategy to minimize blood loss during surgery should be discussed by a multidisciplinary team.
Komura
Reiko
R
Department of Anesthesiology, Niigata University Medical and Dental Hospital, Niigata 951-8520.
Mochida
Takashi
T
Imai
Hidekazu
H
Shibue
Chieko
C
Tobita
Toshiyuki
T
Baba
Hiroshi
H
D000328:Adult; D002585:Cesarean Section; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications; D010921:Placenta Accreta / Q000601:surgery*; D011247:Pregnancy