Advertisement

Canadian Journal of Anaesthesia

, Volume 43, Issue 3, pp 246–251 | Cite as

Anaesthesia for Caesarean hysterectomy in a patient with a preoperative diagnosis of placenta percreta with invasion of the urinary bladder

  • Ted Hunter
  • Simcha Kleiman
  • Jean E. Swenerton
  • Elizabeth A. Peter
  • David C. Campbell
Obstetric Forum

Abstract

Purpose

Placenta Percreta with invasion of the urinary blader is a rare condition, which carries a high morbidity and mortality risk for mother and fetus. We present a case which illustrates some of the complexities of perioperative management.

Principal findings

Anaesthetic considerations include those of the pregnant patient and fetus, potential need for massive transfusion, and possible development of coagulopathy. Ideally, these cases should be diagnosed early enough in pregnancy to allow a multidisciplinary team approach to the management of mother and fetus.

Conclusion

The perioperative care of a patient with placenta previa is complicated but, with a multidisciplinary approach, may be successful.

Key words

anaesthesia: obstetrical surgery: Caesarean hysterectomy obstetrics: placenta previa, placenta percreta, haemorrhage 

Résumé

Objectif

La placenta percreta avec envahissement de la vessie est une condition rare qui comporte un risque élevé de morbidité et de mortalité tant pour la mère que pour le foetus. Les auteurs présente un cas qui illustre les complexités de sa gestion périopératoire.

Principale constatations

L’anesthésiste doit tenir compte de la relation entre la parturiente et son enfant, du besoin potentiel de transfusions massives, et de l’apparition possible d’une coagulopathie. Idéalement, ces cas devraient être diagnostiqués assez précocement pendant la grossesse pour permettre une prise en charge pluridisciplinaire de la mère et de son foetus.

Conclusion

La prise en charge d’une parturiente souffrant d’un placenta percreta est compliquée mais ne peut être couronnée de succès que si quand on adopte une approche multidisciplinaire.

References

  1. 1.
    Meehan FP, Casey C, Costello JN, Connolly CE. Placenta Previa Percreta with bladder involvement. Obstet Gynecol Surv 1989; 44: 835–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Price FV, Resnik E, Heller KA, Christopherson WA. Placenta previa percreta involving the urinary bladder. A report of two cases and review of the literature. Obstet Gynecol 1991; 78: 508–11.PubMedGoogle Scholar
  3. 3.
    Thorp JM Jr, Councell RB, Sandridge DA, Wiest HH. Antepartum diagnosis of Placenta Previa Percreta by magnetic resonance imaging. Obstet Gynecol 1992; 80: 506–8.PubMedGoogle Scholar
  4. 4.
    Legro RS, Price FV, Hill LM, Caritis SN. Placenta percreta: a case report. Obstet Gynecol 1994; 83: 847–9.PubMedGoogle Scholar
  5. 5.
    Bakri YN, Sundin T, Mansi M, Jaroudi K. Placenta Percreta with bladder invasion: report of three cases. Am J Perinatol 1993; 10: 468–70.PubMedGoogle Scholar
  6. 6.
    Breen JL, Neubecker R, Gregori CA, Franklin JE Jr. Placenta Accreta, Increta and Percreta. A Survey of 40 Cases. Obstet Gynecol 1977; 49: 43–7.PubMedGoogle Scholar
  7. 7.
    Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985; 66: 89–92.PubMedGoogle Scholar
  8. 8.
    Rosemond RL, Kepple DM. Transvaginal color Doppler sonography in the prenatal diagnosis of placenta accreta. Obstet Gynecol 1992; 80: 508–10.PubMedGoogle Scholar
  9. 9.
    Hallek M, Dildy GA, Hurley TJ, Moise KJ. Transvaginal pressure pack for life-threatening pelvic hemorrhage secondary to placenta accreta. Obstet Gynecol 1991; 78: 938–40.Google Scholar
  10. 10.
    Sanders RR. Placenta praevia percreta invading the urinary bladder. Aust N Z J Obstet Gynaecol 1992; 32: 375–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Alvarez M, Lockwood CJ, Ghidini A, Dottino P, Mitty HA, Berkowitz RL. Prophylactic and emergent arterial catheterization for selective embolization in obstetric hemorrhage. Am J Perinatol 1992; 9: 441–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Mitty HA, Sterling KM, Alvarez M, Gendler R. Obstetric hemorrhage: prophylactic and emergency arterial catherization and embolotherapy. Radiology 1993; 188: 183–7.PubMedGoogle Scholar
  13. 13.
    Kamani AAS, Gambling DR, Christilaw J, Flanagan ML. Anaesthetic management of patients with placenta accreta. Can J Anaesth 1987; 34: 613–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Arcario T, Greene M, Ostheimer GW, Datta S, Naulty JS. Risks of placenta previa/accreta in patients with previous cesarean deliveries. Anesthesiology 1988; 69: A659.CrossRefGoogle Scholar
  15. 15.
    Chestnut DH, Dewan DM, Redick LF, Caton D, Spielman FJ. Anesthetic management for obstetric hysterectomy: a multi-institutional study. Anesthesiology 1989; 70: 607–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Campbell DC, Camann WR, Datta S. The addition of bupivacaine to intrathecal sufentanil for labor analgesia. Anesth Analg 1995; 81: 305–9.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  • Ted Hunter
    • 1
    • 2
  • Simcha Kleiman
    • 1
    • 2
  • Jean E. Swenerton
    • 3
  • Elizabeth A. Peter
    • 3
  • David C. Campbell
    • 4
  1. 1.Department of Anaesthesia, Room A-335SMBD-Jewish General HospitalMontrealCanada
  2. 2.Department of AnaesthesiaMcGill UniversityCanada
  3. 3.Department of AnaesthesiaBC Women’sVancouver
  4. 4.Department of AnaesthesiaRoyal University HospitalSaskatoon

Personalised recommendations