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Case Studies | Anaesthesiology | Indonesia | Volume 12 Issue 10, October 2023 | Rating: 4.8 / 10
Anaesthetic Management in Patients with Placenta Accreta: A Case Report
Anak Agung Ngurah Aryawangsa, Putu Kurniyanta
Abstract: Placenta accreta is one of the obstetric emergencies that continue to increase along with the increase in caesarean deliveries. We reported a case of a 25 years old woman with gestational age of 34 weeks, transverse position and placenta previa totalis. Vital signs and physical examination were within normal limits. Laboratory examinations were also within normal limits. Abdominal ultrasound examination showed the fetus in a transverse position with placenta closing the internal uterine orifice. She was scheduled for caesarean section and hysterectomy with RA-Subarachnoid Block. No pre-medication was given to the patient. Spinal block anaesthesia was performed by giving 0.5% heavy bupivacaine at L3-L4 as much as 15 mg. After the baby was born, she was evaluated and began to complain of pain and discomfort in the abdomen, therefore the anaesthetic technique was changed to GA-OTT with fentanyl 100 mcg IV, propofol 100 mg IV titrated until the patient was hypnotized, and atracurium 30 mg IV. She was also given Ondansetron 4 mg IV, oxytocin 30 IU IV, tranexamic acid 1000 mg. During the operation, a ruptured bladder was found, therefore primary hecting was performed. Then the operation was followed by a hysterectomy. The operation lasted 5 hours 2 minutes. During the operation, the total bleeding was 1,600 ml and the amount of urineoutpuy was 250 ml. Hemodynamic fluctuations occurred during surgery. After surgery, the patient was given analgesics. In addition, she was also given tranexamic acid 500 mg every 8 hours, ceftriaxone 2 grams every 24 hours. She was treated for five days and was discharged in good condition. A good understanding of the early diagnosis of this disease is needed, planning and good management for patient delivery to prevent patient morbidity and mortality.
Keywords: placenta accreta, hysterectomy, caesarean delivery, bleeding, transfusion
Edition: Volume 12 Issue 10, October 2023
Pages: 34 - 37