ABSTRACT
The pulmonary thromboembolism (PTE) developes occasionally in trauma, surgery and pregnancy. It presents dyspnea, tachycardia, syncope, hypotension and may be fatal by right heart failure. Severe intraoperative PTE is rare. But an intraoperative PTE occurs, it is difficult to diagnose with classic diagnostic measures such as ventilation-perfusion scan, pulmonary angiography, so appropriate management may be delayed. We experienced a case of severe PTE during Ceaserian section of placenta previa totalis. The patient survived and showed complete resolution after 1-year follw-up.
Subject(s)
Humans , Pregnancy , Angiography , Dyspnea , Heart Failure , Hypotension , Placenta Previa , Placenta , Pulmonary Embolism , Syncope , TachycardiaABSTRACT
Traditionally postpartum hemorrhage is a bleeding more than 500 ml that occurs immediately after the placenta is delivered. It remains one of the most common causes of maternal mortality. Morbid adhesion of the placenta is emerging as a major cause of massive postpartum hemorrhage unresponsive to medical therapy. We experienced three cases of major postpartum hemorrhage over 5,000 ml, developed from anterior placenta previa totalis with adhesion of placenta. The hemorrhage had been controlled successfully by compressing abdominal aorta intermittently with the operator's hand during Cesarean hysterectomy. In immediate life- threatening postpartum hemorrhage this simple and safe technique can be used in slowing the bleeding while stabilizing the patient and preparing for definitive treatment.
Subject(s)
Humans , Aorta, Abdominal , Hand , Hemorrhage , Hysterectomy , Maternal Mortality , Placenta , Placenta Previa , Postpartum Hemorrhage , Postpartum PeriodABSTRACT
OBJECTIVE: To determine the dincal significance of placenta previa totalis. METHODS: Maternal and neonatal medical rerords were reviewed retrospectively. Between March 1990 and June 1997, sixty-nine pregnant women with placenta previa totalis delivered at Asan Medical Center. Diagnosis of placenta previa totalis was confirmed during cesarean section. RESULTS: Mean maternal age at diagnosis was 31.7+ 3.9 years and 3 patients(4.3%) were nullipara. Fifty two patients(75%) had the history of vaginal bleeding during their index pregnancy and seventeen of 52 patients were admitted more than once. Median gestational age at the time of initial bleeding episode was 33.2 weeks(range 23.5-41. 1) and median interval from the first admission to delivery was 11 days(range 1-63), Major placental implantation site was posterior uterine wall(64%, 44/69). Six cases(8%) were complicated with placenta accreta or increta and no case was combined with abruptio placentae. Estimated blood loss at the time of cesarean section was 1,510+/-952ml(mean+/-SD) and 43 patients(62%) were transfused. No case was complicated with disseminated intravascular coagulation. Eight patients(11.6%, 8/69) underwent cesarean hysterectomy because of uncontrollable bleeding. Thirty four patients(49.3%) delivered their babies before 37 weeks of gestation. The mean gestational age at delivery was 36.4+/-3.0 weeks(mean+/-SD). Major neonatal morbidity was respiratory distress syndrome(20.3%, 14/69). Perinatal death rate was 4.3%(3/70). CONCLUSION: Because pregnant women complicated with placenta previa totalis have high probability for transfusion and cesarean hysterectomy, these patients should be managed cautiously and thoroughly. The most frequent neonatal morbidity was respiratory distress syndrome due to preterm delivery.