A case of placenta percreta with massive hemorrhage during cesarean section

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  • Kume Katsuyoshi
    Department of Anesthesiology, Tokushima University Hospital
  • M. Tsutsumi Yasuo
    Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
  • Soga Tomohiro
    Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
  • Sakai Yoko
    Department of Anesthesiology, Tokushima University Hospital
  • Kambe Noriko
    Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
  • Kawanishi Ryosuke
    Department of Anesthesiology, Tokushima University Hospital
  • Hamaguchi Eisuke
    Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
  • Kawahara Tomiya
    Department of Anesthesiology, Tokushima University Hospital
  • Kasai Asuka
    Department of Anesthesiology, Tokushima University Hospital
  • Nakaji Yoshimi
    Department of Anesthesiology, Tokushima University Hospital
  • T. Horikawa Yousuke
    Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
  • Nakayama Souichiro
    Department of Obstetrics and Gynecology, Institute of Health Bioscience, the University of Tokushima Graduate School
  • Kaji Takashi
    Department of Obstetrics and Gynecology, Institute of Health Bioscience, the University of Tokushima Graduate School
  • Irahara Minoru
    Department of Obstetrics and Gynecology, Institute of Health Bioscience, the University of Tokushima Graduate School
  • Tanaka Katsuya
    Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School

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We describe a case of a 39-year-old woman diagnosed with placenta percreta complicated by massive hemorrhage during a cesarean section. At 27 weeks of gestation, she underwent an emergency cesarean section under general anesthesia for vaginal bleeding and an intrauterine infection. Soon after delivery, a massive hemorrhage was encountered while attempting to separate the placenta percreta from the bladder wall. Although total abdominal hysterectomy and partial cystectomy were performed, massive hemorrhaging persisted. Bleeding was finally controlled following bilateral internal iliac artery embolization. We used a cell salvage device and a rapid infuser for hemodynamics stabilization. Total blood loss was 47,000 mL, and anesthesia time was 12 h and 47 min. The patient was discharged on the 32nd postoperative day without major complications. Placenta accreta can be associated with life-threatening hemorrhage and it is vital to plan accordingly preoperatively. J. Med. Invest. 61: 208-212, February, 2014

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