Successful resuscitation of a patient with pernicious placenta previa and placenta accreta who had massive life-threatening bleeding during cesarean section: A case report

• Published in: Medicine (Baltimore) 2019-04, Vol.98 (14), p.e15025-e15025
• Main Authors: Jiang, Xiaoqin, Lin, Xuemei, Han, Xueguang, Ma, Yushan, Zhao, Fumin
• Format: Article
• Language: English
• Subjects: Adult; Blood Loss, Surgical; Cesarean Section - adverse effects; Clinical Case Report; Female; Humans; Hysterectomy - methods; Placenta Accreta - surgery; Placenta Previa - surgery; Postpartum Hemorrhage - therapy; Pregnancy; Resuscitation - methods; Treatment Outcome
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000015025

Pernicious placenta accrete (PPP) is an obstetrical complication associated with severe life-threatening hemorrhage, which is one of the leading causes of maternal mortality worldwide. Caesarean hysterectomy is the effective method to control intraoperative bleeding for this unscheduled high-risk patient. But a challenge for clinicians in this case is to determine the optimal timing of hysterectomy, because it will directly determine maternal outcome. We here report a case diagnosed with PPP who suffered from a severe life-threatening hemorrhage during cesarean section but was successfully resuscitated and subsequently discharged from hospital after a smooth recovery. Although binding the lower uterine segment with a tourniquet markedly reduced bleeding in the surgical field after delivery, massive concealed vaginal life-threatening bleeding occurred immediately, and the amount of vaginal blood loss within 10 minutes was as much as 3000 mL. An experienced multidisciplinary team was immediately established, and an unscheduled caesarean hysterectomy was performed immediately, and cell salvage was used. The patient was successfully resuscitated and both the parturient and neonate were well and discharged. If binding the lower uterine segment with a tourniquet markedly reduces bleeding in the surgical field after cesarean delivery in high-risk patients with PPP, and persistence of hypotension after active resuscitation of the circulation is detected, anesthesiologist should be vigilant enough to detect the possibility of concealed vaginal life-threatening bleeding. If this is confirmed, it should be quickly identified whether bleeding can be quickly controlled within a short period of time. If not, the preferred strategy is that the earlier the unscheduled hysterectomy, the better the outcome. A well-established multidisciplinary team and autologous blood recovery and transfusion techniques are also important in ensuring successful resuscitation of patients.