Anesthetic management of patients with placenta implantation undergoing cesarean section / 中华麻醉学杂志

ABSTRACT

The medical records of firstly diagnosed patients with the discharge diagnosis contained " placenta implantation,cesarean section" at Peking University Third Hospital from 2012 to 2016,were collected.The records included the type of placenta implantation,anesthetic methods,intraoperative blood loss,abdominal aorta balloon placement,hysterectomy,requirement for intensive care unit (ICU) admission and length of hospital stay,and the anesthetic management experience was summarized in the patients with placenta implantation undergoing cesarean section.A total of 156 patients were included in this study,and among the 156 patients,there were 70 cases of accreta (44.9％),50 cases of increta (32.1％) and 36 cases of percreta (23.1％).The intraoperative blood loss was (624±451) ml,(2100±1283) ml and (5281 ±3114) ml,the ratio of neuraxial anesthesia was 92％,62％ and 14％,the ratio of neuraxial anesthesia combined with general anesthesia was 4％,20％ and 61％,and the ratio of general anesthesia was 4％,18％ and 25％ in the patients of accreta,of increta and of percreta,respectively.The abdominal aorta balloon was placed during surgery in 14 cases,and among the 14 cases,there were 3 cases of increta and 11 cases of percreta.Forty-nine patients were transferred to ICU after operation,and among the 49 patients,there was 1 case of accreta,16 cases of increta and 32 cases of percreta.Anesthesiologists should pay attention to the preoperative interview and assessment,actively try to work with multi-departments,make anesthetic regimen according to patient's condition,closely monitor patient's vital signs during operation,concern about the operating process and blood loss,and ensure proper infusion and transfusion for the patients with placenta implantation undergoing cesarean section,and in addition,the critically ill patients should be transferred to ICU after operation for intensive monitoring and treatment.