Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report

• Published in: Korean journal of anesthesiology Vol. 67; no. 4; pp. 279 - 282
• Main Authors: Lee, Jae Woo, Song, In Ae, Ryu, Junghee, Park, Hee-Pyoung, Jeon, Young-Tae, Hwang, Jung-Won
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Anesthesiologists 01-10-2014; Korean Society of Anesthesiologists; 대한마취통증의학회
• Subjects: Case Report; cesarean section; epidural anesthesia; placenta previa; spinal anesthesia; uterine artery embolization; 마취과학; Placenta previa; Uterine artery embolization; Cesarean section; Epidural anesthesia; Spinal anesthesia
• ISSN: 2005-6419; 2005-7563
• DOI: 10.4097/kjae.2014.67.4.279

Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.