Korean J Anesthesiol.  2014 Oct;67(4):279-282. 10.4097/kjae.2014.67.4.279.

Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report

• Lee JW
• Song IA
• Ryu J
• Park HP
• Jeon YT
• Hwang JW

• KMID: 1937689
• DOI: http://doi.org/10.4097/kjae.2014.67.4.279

Abstract

Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.

Keyword

Cesarean section; Epidural anesthesia; Placenta previa; Spinal anesthesia; Uterine artery embolization

MeSH Terms

Adult
Anesthesia
Anesthesia, Epidural
Anesthesia, Spinal
Cesarean Section
Erythrocytes
Female
Fetus
Hemorrhage
Humans
Leiomyoma
Placenta
Placenta Previa*
Postpartum Hemorrhage
Postpartum Period
Pregnancy
Uterine Artery
Uterine Artery Embolization*