Anesth Pain Med.  2020 Jul;15(3):314-318. 10.17085/apm.19051.

Successful management of uncontrolled postpartum hemorrhage due to morbidly adherent placenta with Resuscitative endovascular balloon occlusion of the aorta during emergency cesarean section - A case report -

• Ji SM
• Cho C
• Choi G
• Song J
• Kwon MA
• Park JH
• Kim S

• KMID: 2504893
• DOI: http://doi.org/10.17085/apm.19051

Abstract

Background
Morbidly adherent placenta (MAP) may cause life-threatening postpartum hemorrhage (PPH) requiring massive transfusions. Furthermore, it could endanger the lives of both mother and baby. Despite various efforts, such as adjuvant endovascular embolization and hysterectomy, massive PPH due to MAP still occurs and is difficult to overcome. Case: Herein, we described the case of a 40-year-old woman with placenta previa totalis who experienced massive bleeding during a cesarean section. We used resuscitative endovascular balloon occlusion of the aorta (REBOA) and it improved the condition of the surgical field and the hemodynamic stability of the patient temporarily. The patient was successfully managed without further complications.
Conclusions
REBOA can be used as a rescue procedure for uncontrolled bleeding situations in patients with MAPs. Anesthesiologists should consider and recommend REBOA as another resuscitative therapeutic option in the case of massive PPH.

Keyword

Balloon occlusion; Cesarean section; Placenta previa; Postpartum hemorrhage; Resuscitation

Figure

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  Fig. 1. Preoperative ultrasonography findings of the patient’s placenta indicating suspicious placenta previa with accreta.

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  Fig. 2. Flow chart of the patient’s blood pressure and heart rate during surgery.

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