Abstract
Background: Placenta accreta represents one of the most morbidity conditions in modern obstetrics, with high hemorrhage rates, hysterectomy, and intensive care unit admission. Alternative management during intraoperative bleeding is haemodilution. There are two techniques in hemodilution, including autonomic normovolemic hemodilution and hypervolemic hemodilution. Case: A gravida patient, physical status ASA II with a suspected placenta accreta was planned for a cesarean section. Hypervolemic hemodilution was conducted to anticipate bleeding. Hemodilution was performed with a total fluid of 2000 ml. Total bleeding during surgery is 3500 ml. Close monitoring of hemoglobin (Hb) and hematocrit (Hct) was conducted. The initial Hb and Hct were 9.9 mg/dl and 29.8%. Hb and Hct post-haemodilution 5.7 mg/dl, and 17.1%. Postoperatively, Hb and Hct become 5.4 mg/dl and 16.6%. The patient has been given 450 ml packed red cells (PRC) blood transfusion. The patient was observed in the intensive care unit for 24 hours postoperatively and was subsequently transferred to the ward. The total bleeding was 3500 ml, and there was a reduction of Hb from 5.7 to 5.4 and Hct from 17.7% to 16.6%. Conclusion: In this case, hemodilution was proven effective based on the post-hemodilution and post-hemorrhage Hb and Hct. Hemodilution may be alternative management during intraoperative hemorrhage. However, the anticipation and effect that might arise from hemodilution should be considered.
Highlights
Placenta accreta represents one of the most morbidity conditions in modern obstetrics, with high hemorrhage rates, hysterectomy and intensive care unit admission
Hemostasis often cannot be achieved promptly in cases of massive hemorrhage during cesarean section, accompanied by disseminated intravascular coagulation (DIC). In such obstetric facts with DIC, in the presence of hypothermia, acidosis, and vasopressor requirement, damage control surgery (DCS) and resuscitation, which represent the performing of the therapeutic concept of life-saving intervention for severe trauma because ordinary hemostatic procedures such as sutures, ligation, and coagulation, etc., are not effective and bleeding persists.[1,2]
It can significantly reduce the amount of intraoperative blood loss, help control the demand for allogeneic blood, reduce adverse reactions and disease transmission caused by blood transfusion, save blood resources, and reduce the medical burden of patients
Summary
Placenta accreta represents one of the most morbidity conditions in modern obstetrics, with high hemorrhage rates, hysterectomy, and intensive care unit admission. Alternative management during intraoperative bleeding is haemodilution. Case: A gravida patient, physical status ASA II with a suspected placenta accreta was planned for a cesarean section. Hypervolemic hemodilution was conducted to anticipate bleeding. Total bleeding during surgery is 3500 ml. Hb and Hct become 5.4 mg/dl and 16.6%. The patient was observed in the intensive care unit for 24 hours postoperatively and was subsequently transferred to the ward. The total bleeding was 3500 ml, and there was a reduction of Hb from 5.7 to 5.4 and Hct from 17.7% to 16.6%. Conclusion: In this case, hemodilution was proven effective based on the post-hemodilution and post-hemorrhage Hb and Hct. Hemodilution may be alternative management during intraoperative hemorrhage. Hypervolemic Hemodilution as a Management During Predicted Massive Bleeding Sectio Caesarea In Placenta Accreta Patient.
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