Case Report: Saving a Pregnant Woman from Pulmonary Embolism and Massive Hemorrhage due to Placenta Precreta with Invasion to Bladder

Document Type : Case Report

Authors

1 Assistant Professor, Anesthesiology and Critical Care Research Center AND Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Although there has been a significant reduction in morbidity and mortality of gynecological patients due to new advancement in medical sciences, post caesarean section hemorrhage is still a major cause of maternal mortality and the reason for half postpartum deaths.Case Report: A 37 years old woman, 37 week gestation, with a history of two previous caesarean sections and two curettages and placenta accrete was being treated for pulmonary embolism. In sonography, placenta accrete with diffusion to bladder was diagnosed. She was rushed to operation room because of pulmonary hypertension and underwent caesarean section. Massive hemorrhage happened after the fetus was delivered, so hysterectomy was performed with bilateral hypogastric artery ligation because of placental penetration into bladder and lateral side of pelvis and two big-size drains were placed due to diffuse oozing. The infused volume of crystalloid and blood components to the patient was increased but disseminated intravascular coagulation happened as a complication of dilution coagulopathy and massive transfusion which was managed with fresh frozen plasma (FFP) and platelet transfusion. By the end of surgery, the patient underwent cardiac arrest, but was resuscitated in less than five minutes and the heart rate went back to normal and vital signs became stable. The patient was transferred to intensive care unit with tracheal tube in-place. One week later, the patient underwent acute respiratory distress syndrome but her condition improved after two weeks and she was discharged.Conclusion: Placenta precreta surgery is associated with severe bleeding and high volume of fluid and blood may be required to stabilize the vital signs. Infusion rate should be reduced afterwards and patient's systolic pressure be kept between 70 and 100 mm Hg so that possible dilution coagulopathy would not happen as a complications of this massive transfusion.

Keywords

References

  1. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams obstetrics. 23th ed. New York, NY: McGraw-Hill; 2009.
  2. Bergakker SA. Case report: management of elective cesarean delivery in the presence of placenta previa and placenta accrete. AANA J 2010; 78(5): 380-4.
  3. Tong SY, Tay KH, Kwek YC. Conservative management of placenta accreta: Review of three cases. Singapore Med J 2008; 49(6): 156-159.
  4. Leung AN, Bull TM, Jaeschke R, Lockwood CJ, Boiselle PM, Hurwitz LM, et al. An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med 2011; 184(10): 1200-8.
  5. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359(19): 2033-25.
  6. Zaki ZM, Bahar AM, Ali ME, Albar HA, Gerais MA. Risk factors and morbidity in patients with placenta previa accreta compared to placenta previa non-accreta. Acta Obstet Gynecol Scand 1998; 77(4): 391-4.
  7. Ayati S, Vahidroodsari F, Talebian M. Maternal death due to placenta percreta with bladder involvement: a case report. Tehran Univ Med J 2011; 69(6): 399-402. [In Persian].
  8. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's anesthesia. 8th ed. Philadelphia, PA: Saunders; 2014.
  9. Vincent JL, Abraham E, Kochanek P , Moore FA , Fink MP. Text book of critical care. 6th ed. Philadelphia, PA: Saunders; 2011.
Journal of Isfahan Medical School
Volume 34, Issue 369 - Serial Number 369
January and February 2016
Pages 35-40

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History

  • Receive Date: 10 October 2015
  • Revise Date: 26 May 2024
  • Accept Date: 06 April 2022

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