Anesthetic Management in the Abnormal Placental Invasion

Year 2019, Volume: 28 Issue: 3, 177 - 183, 30.09.2019

Murat Türkeün Ilgınel

https://doi.org/10.17827/aktd.418016

Cited By: 1

Abstract

Abnormal placental invasion (API) is one of the causes of peripartum hemorrhage. API associated maternal morbidity or mortality is mainly due to massive hemorrhage, in particular after attempts at forced manual removal of the placenta. Several risk factors for API are known and may lead to the diagnosis. Previous cesarean section and placenta previa in present pregnancy constitute major risk factors for API. The perioperative management of patients with API requires close coordination amongst anesthesiologists, obstetricians, interventional radiologists and blood bank providers. Due to the significant risk of massive bleeding complicated by profound hypotension and coagulopathy and a high likelihood of hysterectomy during cesarean delivery, general anesthesia is generally regarded as the anesthetic choice for patients with API. A well-organized hemorrhage protocol using surgical, pharmacologic, and transfusion approaches has an important role in decreasing the morbidity and mortality associated with API. In this review, the perioperative anesthesia management of a patient with abnormal placental invasion will be described. 

Keywords

Abnormal placental invasion, anesthetic management, blood transfusion

Anormal Plasental İnvazyonda Anestezi Yönetimi

Abstract

Anormal plasental invazyon perpartum hemorajinin önemli ve sık görülen nedenlerinden biridir. Maternal morbidite ve mortalite, özellikle plasentanın uterustan ayrılma girişimleri sırasındaki masif kanamaya bağlıdır. Anormal plasental invazyonda iyi belirlenmiş risk faktörleri tanı koyulmasında yardımcı olmaktadır. Daha önce geçirilmiş sezeryan ve mevcut gebelikteki plasenta previa majör risk faktörlerini oluşturmaktadır. Diğer risk faktörleri uterus cerrahisi, ileri anne yaşı ve parite, sigara kullanım öyküsüdür. Anormal plasental invazyonu olan hastaların yönetiminde anestezist, kadın hastalıkları ve doğum uzmanı, girişimsel radyolog ve kan merkezi sorumluları arasında yakın bir koordinasyon gerekmektedir. Preoperatif kapsamlı planlama ile kan kaybının, kan ve kan ürünleri ihtiyacının perioperatif morbidite ve mortaliteyi azalttığı gösterilmiştir.

Derin hipotansiyon ve koagülopati ile komplike olabilen masif kanama riski ve sezaryen sırasında histerektomi olasılığı nedeniyle, anormal plasental invazyonu olan hastalarda genellikle genel anestezi  tercih edilmektedir. 

Cerrahi, farmakolojik ve transfüzyon yaklaşımlarını kullanarak ve hastaya ait faktörler de göz önünde bulundurularak planlanmış bir kanama protokolü, anormal plasental invazyonla ilişkili morbidite ve mortaliteyi azaltmada yardımcı olmaktadır.

Keywords

Anormal plasental yerleşim, anestezi yönetimi, kan transfüzyonu

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