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B229 Perioperative management of a multigravida at 35-week gestation diagnosed with placenta accreta: a case report
  1. K Paramés,
  2. JL Beisl Ramos,
  3. I Capito and
  4. F Lança
  1. Centro Hospitalar Universitário Lisboa Norte, E.P.E, Lisboa, Portugal


Background and Aims Placenta accreta spectrum is a leading cause of major obstetric haemorrhage and severe maternal morbidity in the developed world. With an increasing incidence in recent years, it remains an entity with significant anaesthetic implications for which anaesthesiologists should be aware.

Methods The authors describe the perioperative management of a 35-week pregnant woman with an antenatal diagnosis of placenta accreta vera (PAV) proposed to elective caesarean section with total hysterectomy. The patients’ obstetric history included placenta previa and two previous caesarean sections. Since PAV was diagnosed early, multidisciplinary planning was possible and included a careful antenatal anaesthesia consultation. Preoperatively, occlusion balloon catheters were placed into the internal iliac arteries under monitored anesthesia care and sedation with remifentanil. Balanced general anesthesia was performed by patient’s choice. After delivery of the fetus, the occlusion balloon catheters were inflated to reduce uterine perfusion during the hysterectomy and thus prevent massive blood loss. Strategy for hemodynamic and haemorrhagic control also included two large-bore venous accesses, invasive arterial and urinary output monitoring, serial blood gas and thromboelastometry analysis, administration of tranexamic acid and fibrinogen, and low-dose noradrenaline infusion.

Results The procedure was successfully performed and there were no major surgical complications, including massive blood loss, although blood transfusion was required at 24h postoperatively. With no need for admission in an intensive care unit, the patient was discharged within 96 hours.

Conclusions Perioperative well-coordinated multidisciplinary communication can positively impact the outcomes of women with PAV undergoing elective caesarean section with hysterectomy.

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