Background and Aims Placenta accreta is a spectrum disorder ranging from abnormally adherent to deeply invasive placental tissue. It is frequently associated with major obstetric haemorrhage. Multidisciplinary planning is vital in optimising maternal and fetal outcomes. In this case report, we describe some important considerations for the anaesthetist planning the use of neuraxial techniques for prophylactic procedures prior to caesarean section. Awareness of the limitations of patient positioning for these procedures is required in order to avoid difficulties in administering neuraxial blockade. In particular, the need to avoid hip flexion following iliac artery balloon insertion can hinder subsequent patient positioning for spinal or epidural anaesthesia.
Methods Case report and review of the literature.
Results A 47 year old parturient with placenta accreta, possibly invading the cervix and bladder serosa, presented for elective caesarean section. Prophylactic measures to reduce the risk of major haemorrhage began with radiological iliac artery occlusion balloon insertion under local anaesthetic. Thereafter, she underwent spinal anaesthesia to facilitate cystoscopy and prophylactic bilateral ureteric stent insertion. However, due to the need to avoid hip flexion and the risk of dislodging the balloon catheters, these procedures had to be carried out with the patient in a suboptimal position. The intrathecal block was administered with the patient in the left lateral position, without any hip or knee flexion, increasing technical difficulty. We discuss the implications of this and possible solutions.
Conclusions Multidisciplinary planning can help avoid potential pitfalls in administering neuraxial techniques to patients with placenta accreta undergoing multiple prophylactic procedures.
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