[Massive hemorrhage associated with undiagnosed placenta percreta in a second-trimester pregnancy receiving abortion procedure].
A 26-year-old woman presented with an incomplete miscarriage and was scheduled for curettage at 21 weeks of gestation. She received curettage under spinal anesthesia and vaginal hemorrhage could not be controlled due to placenta percreta and cesarean section was immediately performed. Profuse bleeding continued and the patient developed hemorrhagic shock. For the purpose of circulatory and respiratory management, general anesthesia was induced and a hysterectomy was performed. For treatment of hemorrhage-induced hypotension, dobutamine and norepinephrine were administrated, while fluid replacement was continued with packed blood cells. Hemorrhagic shock, however, was not responsive to catecholamines, and her arterial pressure decreased to 40/20 mmHg. She received a bolus injection of vasopressin, 1 U, by i.v. push. Her arterial pressure increased to 140/65 mmHg after vasopressin administration, and catecholamines were tapered off before operation was finished. The patient's total blood loss was estimated to be approximately 6,000 ml. She recovered without complications and was discharged on the 7th postoperative day. Vasopressin may be an option to stabilize cardiocirculatory function in patients with uncontrolled hemorrhagic shock.
Komiya
Kaori
K
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Shimotsuke 320-0298.
Saitou
Kazuhiko
K
Inoue
Souichirou
S
Igarashi
Takashi
T
Hirabayashi
Yoshihiro
Y
Seo
Norimasa
N
D000022:Abortion, Spontaneous / Q000209:etiology / Q000601:surgery*; D000032:Abortion, Therapeutic; D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007275:Injections, Intravenous; D007430:Intraoperative Care; D010921:Placenta Accreta / Q000601:surgery*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012771:Shock, Hemorrhagic / Q000188:drug therapy* / Q000209:etiology*; D014592:Uterine Hemorrhage / Q000188:drug therapy* / Q000209:etiology*; D014667:Vasopressins / Q000008:administration & dosage*
D014667:Vasopressins