pituitrin and Placenta-Accreta

The rising Caesarean section rate in the developing world implies that the incidence of placenta accreta might be on the increase and this might worsen the maternal mortality burden.. To draw the attention of Obstetricians and other relevant professionals to this emerging but challenging trend.. Original research findings and reviews published in the English literature. Additional information was obtained from texts and electronic books such as CD ROMS.. Online searches of electronic database (Medline, Pubmed and Embase), requests for reprints from corresponding authors and institutional/private subscriptions.. Information obtained was categorised accordingly.. Optimal treatment of women with placenta accreta requires recognition of the clinical risk factors, accurate pre-operative diagnosis and meticulous planning to ensure safety at the time of delivery. In view of the rising incidence of this condition, and the absence of a highly reliable antenatal diagnostic method especially in developing countries, a high index of suspicion and advanced preparation is required to reduce its associated maternal morbidity and mortality.

Topics: Developing Countries; Female; Humans; Hysterectomy; Incidence; Placenta Accreta; Pregnancy; Prenatal Diagnosis; Risk Factors; Vasoconstrictor Agents; Vasopressins

A 26-year-old woman presented with an incomplete miscarriage and was scheduled for curettage at 21 weeks of gestation. She received curettage under spinal anesthesia and vaginal hemorrhage could not be controlled due to placenta percreta and cesarean section was immediately performed. Profuse bleeding continued and the patient developed hemorrhagic shock. For the purpose of circulatory and respiratory management, general anesthesia was induced and a hysterectomy was performed. For treatment of hemorrhage-induced hypotension, dobutamine and norepinephrine were administrated, while fluid replacement was continued with packed blood cells. Hemorrhagic shock, however, was not responsive to catecholamines, and her arterial pressure decreased to 40/20 mmHg. She received a bolus injection of vasopressin, 1 U, by i.v. push. Her arterial pressure increased to 140/65 mmHg after vasopressin administration, and catecholamines were tapered off before operation was finished. The patient's total blood loss was estimated to be approximately 6,000 ml. She recovered without complications and was discharged on the 7th postoperative day. Vasopressin may be an option to stabilize cardiocirculatory function in patients with uncontrolled hemorrhagic shock.

Topics: Abortion, Spontaneous; Abortion, Therapeutic; Adult; Anesthesia, General; Anesthesia, Obstetrical; Anesthesia, Spinal; Cesarean Section; Female; Humans; Hysterectomy; Injections, Intravenous; Intraoperative Care; Placenta Accreta; Pregnancy; Pregnancy Trimester, Second; Shock, Hemorrhagic; Uterine Hemorrhage; Vasopressins

A case of transient myocardial ischemia following subendometrial vasopressin infiltration in intractable intra-operative postpartum bleeding due to placenta accreta is described. In our experience, the rate of this side effect is one in 14 patients (rate of 7.1%). We believe that the benefits of the treatment outweigh the risks, since the uterus was saved in all 14 patients. Nevertheless, this case emphasises that extreme precaution is needed with subendometrial vasopressin infiltration. It should be emphasised that the needle must not be within a blood vessel because intravascular injection of vasopressin solution can precipitate acute arterial hypertension, bradycardia and even death. We suggest that local vasopressin infiltration into the placental site is indicated in cases of intractable bleeding at cesarean section after other conventional obstetric and pharmacological maneuvers have failed.

Topics: Blood Loss, Surgical; Cesarean Section; Female; Hemostatics; Humans; Myocardial Ischemia; Placenta Accreta; Pregnancy; Uterine Hemorrhage; Vasopressins

Topics: Adult; Cesarean Section; Female; Hemostatics; Humans; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Vasopressins

Topics: Adult; Female; Humans; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Vasopressins