losartan-potassium and Placenta-Accreta

Placenta percreta is increasing in incidence and is associated with the risk of life-threatening haemorrhage. Patients who do not accept blood products present a unique challenge to obstetrician-gynaecologists. In this case report, we present the case of a 42-year-old pregnant Jehovah's Witness with a complete placenta previa and confirmed percreta at 26 weeks' gestation. Due to her religious beliefs against the use of blood products, she was managed with a stepwise surgical approach which involved caesarean delivery with internal iliac (hypogastric) artery ligation, weekly methotrexate and delayed hysterectomy 6 weeks later. Non-traditional, alternative approaches to the management of abnormal placentation in patients declining blood products warrant exploration.

Topics: Adult; Blood Transfusion; Cesarean Section, Repeat; Erythropoietin; Female; Humans; Hysterectomy; Jehovah's Witnesses; Magnetic Resonance Imaging; Methotrexate; Placenta Accreta; Placenta Previa; Pregnancy; Treatment Refusal; Ultrasonography, Prenatal; Uterine Hemorrhage

Abnormal placentation can be associated with significant blood loss and massive blood transfusions. Caring for parturients with abnormal placentation who refuse blood transfusion is very challenging. We present a 35-year-old, gravida 3, para 1, Jehovah's Witness at 35 weeks of gestation with placenta percreta, who underwent cesarean delivery and delayed hysterectomy. A multidisciplinary team developed a plan, including the use of perioperative erythropoietin and IV iron dextran, intraoperative acute normovolemic hemodilution, cell salvage, tranexamic acid, and uterine artery embolization. This strategy was successful in avoiding the need for allogeneic transfusion and ensuring an uneventful recovery after both surgical procedures.

Topics: Adult; Bloodless Medical and Surgical Procedures; Combined Modality Therapy; Erythropoietin; Female; Hemodilution; Humans; Iron-Dextran Complex; Jehovah's Witnesses; Placenta Accreta; Placenta Previa; Pregnancy; Tranexamic Acid; Treatment Outcome; Uterine Artery Embolization

A massive obstetric hemorrhage resulting in an extremely low hematocrit (5.9%) required innovative intraoperative and postoperative management. We used a combination of rapid intraoperative volume replacement, aortic compression, chemical coma, high-dose erythropoietin, and enteral iron replacement to elevate the hematocrit in a patient refusing blood transfusions.

Topics: Adult; Blood Transfusion, Autologous; Deep Sedation; Erythropoietin; Female; Humans; Hysterectomy; Jehovah's Witnesses; Placenta Accreta; Placenta Previa; Pregnancy; Treatment Refusal