Spinal Anesthesia in a Patient with Complete Placenta Previa and Suspected Placenta Accreta Undergoing Cesarean Hysterectomy: Is it Possible?

Irwanda , A.D.I., Handrawan, S.H, M.I. Lestari

Abstract

Background : Placenta accreta spectrum (PAS) is a major contributor to peripartum hemorrhage and an important cause of maternal morbidity and mortality. Anesthetic management in such cases requires planning to minimize complications.
Case Illustration : This report describes the perioperative management of a 39-year-old woman, gravida 4 para 2 at 35 weeks' gestation, who was diagnosed with complete placenta previa and suspected placenta accreta based on ultrasonography and clinical presentation. She underwent cesarean section followed by hysterectomy under spinal anesthesia using 0.5% hyperbaric bupivacaine (12 mg) and clonidine (30 mcg) at the L4-L5 interspace. Intraoperative monitoring included non-invasive blood pressure, ECG, SpO₂, EtCO₂, body temperature, urine output, and serial blood glucose. The operation lasted approximately 2.5 hours with an estimated blood loss of 2000 ml. Fluid resuscitation consisted of crystalloids, albumin, and packed red cells, achieving a calculated fluid replacement of 11.1 mL/kg/h. The baby was delivered in good condition with an APGAR score of 7 and 9 at 1 and 5 minutes, respectively. Postoperative recovery within 24 hours was stable, with minimal pain and no complications.
Conclusion : This case demonstrates that with appropriate preparation, spinal anesthesia can be safely and effectively used in selected patients with PAS.

Keywords

Hysterectomy; Placenta Acccreta; Placenta Previa Totalis; Section Caesaria.

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References

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DOI: https://doi.org/10.20961/soja.v5i1.61448

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