Case ReportAcute normovolemic hemodilution, intraoperative cell salvage and PulseCO hemodynamic monitoring in a Jehovah’s Witness with placenta percreta
Introduction
Life-threatening intraoperative hemorrhage is a known and feared complication of placenta percreta. Patients who refuse blood transfusion, for religious or other reasons, present an additional challenge for anesthetic management. Well-planned strategies for blood conservation and decisive surgical technique can help to achieve an acceptable outcome.
Section snippets
Case report
A 42-year-old, 100-kg woman, gravida 6, para 4, who had had four previous cesarean deliveries, was referred to our institution at 34 weeks of gestation for management of placenta previa. Ultrasound was highly suggestive of placenta percreta with bladder involvement.
The patient was a Jehovah’s Witness who adamantly refused transfusion of blood products and expressed full understanding of the consequences of this decision. She said she would accept erythropoietin injections and oral iron.
Discussion
The success of this case depended on extensive advance discussion and planning. Our first goal was to make sure that the patient fully understood the implications of her decision not to receive blood products. She was interviewed alone, so that no undue influence might be applied to her by family members or religious advisors. Both the obstetrical and anesthesia teams talked with the patient at length and were convinced that she sincerely would rather die than receive blood products. Before
References (9)
- et al.
Normovolemic hemodilution before cesarean hysterectomy for placenta percreta
Obstet Gynecol
(1997) - et al.
Arterial Pulse Power Analysis: The LiDCO System
- Thomas D (proposer), Clark V (opposer). Controversies in obstetric anesthesia: Facilities for blood salvage (cell saver...
- Waters J H, Santrach P J. Pro/con debate: Is cell salvage a safe technique for the obstetric patient?. SOAP Newsletter...