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Tytuł:
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[Massive hemorrhage associated with undiagnosed placenta percreta in a second-trimester pregnancy receiving abortion procedure].
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Autorzy:
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Komiya K; Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Shimotsuke 320-0298.
Saitou K
Inoue S
Igarashi T
Hirabayashi Y
Seo N
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Źródło:
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Masui. The Japanese journal of anesthesiology [Masui] 2009 Aug; Vol. 58 (8), pp. 1036-8.
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Typ publikacji:
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Case Reports; English Abstract; Journal Article
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Język:
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Japanese
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Imprint Name(s):
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Publication: Tokyo : Nippon Masui Gakki
Original Publication: Tokyo.
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MeSH Terms:
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Abortion, Therapeutic*
Anesthesia, General*
Anesthesia, Obstetrical*
Anesthesia, Spinal*
Intraoperative Care*
Pregnancy Trimester, Second*
Abortion, Spontaneous/*surgery
Placenta Accreta/*surgery
Shock, Hemorrhagic/*drug therapy
Shock, Hemorrhagic/*etiology
Uterine Hemorrhage/*drug therapy
Uterine Hemorrhage/*etiology
Vasopressins/*administration & dosage
Abortion, Spontaneous/etiology ; Adult ; Cesarean Section ; Female ; Humans ; Hysterectomy ; Injections, Intravenous ; Pregnancy
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Substance Nomenclature:
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11000-17-2 (Vasopressins)
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Entry Date(s):
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Date Created: 20090826 Date Completed: 20091117 Latest Revision: 20090825
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Update Code:
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20240104
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PMID:
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19702228
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A 26-year-old woman presented with an incomplete miscarriage and was scheduled for curettage at 21 weeks of gestation. She received curettage under spinal anesthesia and vaginal hemorrhage could not be controlled due to placenta percreta and cesarean section was immediately performed. Profuse bleeding continued and the patient developed hemorrhagic shock. For the purpose of circulatory and respiratory management, general anesthesia was induced and a hysterectomy was performed. For treatment of hemorrhage-induced hypotension, dobutamine and norepinephrine were administrated, while fluid replacement was continued with packed blood cells. Hemorrhagic shock, however, was not responsive to catecholamines, and her arterial pressure decreased to 40/20 mmHg. She received a bolus injection of vasopressin, 1 U, by i.v. push. Her arterial pressure increased to 140/65 mmHg after vasopressin administration, and catecholamines were tapered off before operation was finished. The patient's total blood loss was estimated to be approximately 6,000 ml. She recovered without complications and was discharged on the 7th postoperative day. Vasopressin may be an option to stabilize cardiocirculatory function in patients with uncontrolled hemorrhagic shock.