Gambaran Jumlah Perdarahan pada Seksio Sesarea Spektrum Plasenta Akreta di RSUP Hasan Sadikin Bulan Januari 2020-Desember 2021
Abstract
Latar Belakang: Masalah morbiditas dan mortalitas pada pasien dengan spektrum plasenta akreta (SPA) berkaitan erat dengan perdarahan masif perioperatif, sehingga diperlukan strategi pemberian transfusi darah yang tepat.
Tujuan: Penelitian ini bertujuan untuk mengetahui gambaran jumlah perdarahan pada seksio sesarea atas indikasi dengan spektrum plasenta akreta.
Subjek dan Metode: Penelitian ini adalah deskriptif observasional dengan desain potong lintang. Penelitian dilakukan di RSUP Dr. Hasan Sadikin Bandung dari Januari 2020 sampai Desember 2021 dengan sampel penelitian berjumlah 50 orang yang terbagi dua berdasarkan skor Placenta Accreta Index (PAI), yaitu kelompok skor PAI <5 dan >5. Dicatat kadar hemoglobin pra dan pascabedah, jenis tindakan penjepitan aorta dan yang tidak dilakukan penjepitan, jumlah perdarahan, serta jumlah pemberian transfusi darah.
Hasil: Penelitian ini memperoleh hasil perdarahan rata-rata sebesar 3.135 cc dan Hb pascaoperasi rata – rata 8,32 pada kelompok skor PAI <5 dan 8.186 cc dan Hb pasacaoperasi rata – rata 7,73 pada skor PAI >5.
Simpulan: Dari hasil penelitian ini dapat disimpulkan bahwa pasien dengan gangguan spektrum plasenta akreta dengan skor PAI ≥ 5 memiliki jumlah perdarahan yang lebih banyak dan tindakan penjepitan aorta dilakukan lebih dari 80% pasien
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References
Einerson BD, Weiniger CF. Placenta accreta spectrum disorder: updates on anesthetic and surgical management strategies. Int J Obstet Anesth. 2021, 102975.
Ismail S. Placenta accreta: anesthetic management and resuscitation strategies. Anaesth Pain Intensive Care. 2019;18(4):371–6.
Hawkins R, Evans M, Hammond S, Hartopp R, Evans E. Placenta accreta spectrum disorders - Peri-operative management: The role of the anaesthetist. Best Pract Res Clin Obstet Gynaecol. 2021;72:38–51.
Ochiai D, Abe Y, Yamazaki R, Uemura T, Toriumi A, Matsuhashi H, et al. Clinical results of a massive blood transfusion protocol for postpartum hemorrhage in a university hospital in Japan: A retrospective study. Medicina. 2021;57(9):983.
Patil V, Ratnayake G, Fastovets G, Wijayatilake DS. Clinical pearls part 3: Anaesthetic management of abnormally invasive placentation. Curr Opin Anaesthesiol. 2018;31(3):280–89.
Ahmad M. Strategies for anesthesia management of cesarean deliveries with abnormal placental placement–anesthetist’s perspective. Pakistan Armed Forces Med J. Army Medical College. 2021;71(5):1778–81.
Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Placenta accreta spectrum. American College of Obstetricians and Gynecologists. 2021, 722–33.
Li P, Liu X, Li X, Wei X, Liao J. Clinical outcomes and anesthetic management of pregnancies with placenta previa and suspicion for placenta accreta undergoing intraoperative abdominal aortic balloon occlusion during cesarean section. BMC Anesthesiol. 2020;20(1).
Snegovskikh D, Clebone A, Norwitz E. Anesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhage. Curr Opin Anaesthesiol. 2011;24(3):274–81.
Apfelbaum JL, Hawkins JL, Agarkar M, Bucklin BA, Connis RT, Gambling DR, et al. Practice guidelines for obstetric anesthesia: an updated report by the american society of anesthesiologists task force on obstetric anesthesia and the society for obstetric anesthesia and perinatology *. Anesthesiology. American Society of Anesthesiologists; 2016;124(2): 270–300.
Rosen T. Placenta accreta and cesarean scar pregnancy: Overlooked costs of the rising cesarean section rate. Clin Perinatol. 2008; 35(3):519–29.
Waters JH, Bonnet MP. When and how should I transfuse during obstetric hemorrhage? Int J Obstet Anesth. 2021;46:102973.
Stotler B, Padmanabhan A, Devine P, Wright J, Spitalnik SL, Schwartz J. Transfusion requirements in obstetric patients with placenta accreta. Transfusion. Transfusion; 2011;51(12):2627–33.
Stainsby D, MacLennan S, Hamilton PJ. Management of massive blood loss: A template guideline. Br J Anaesth. 2000;85(3):487–91.
Butwick AJ, Goodnough LT. Transfusion and coagulation management in major obstetric hemorrhage. Curr Opin Anaesthesiol. 2015;28(3):275–84.
El Gelany S, Mosbeh MH, Ibrahim EM, Mohammed M, Khalifa EM, Abdelhakium AK, et al. Placenta accreta spectrum (PAS) disorders: Incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: A prospective study. BMC Pregnancy Childbirth. 2019 Aug 27;19(1):1–8. Tersedia di: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2466-5.
Qatrunnada A, Antonius PA, Yusrawati Y. Faktor risiko dan luaran maternal plasenta akreta di RSUP Dr. M. Djamil Padang. Obgynia. 2018 ;1(2):97–102.
Tia HY, Kumaat LT, Lalenoh DC. Gambaran kadar hemoglobin pasien pra dan pasca operasi seksio sesarea yang tidak mendapat transfusi darah. e-CliniC (eCl). 2016;4(2).
Allen L, Jauniaux E, Hobson S, Papillon-Smith J, Belfort MA, Duncombe G, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management. Int J Gynecol Obstet. 2018;140(3):281–90.
Hobson SR, Kingdom JCP, Windrim RC, Murji A, Milligan N, Pacheco JF, et al. Safer outcomes for placenta accreta spectrum disorders: A decade of quality improvement. Int J Gynecol Obstet. 2022;157(1):130–9. Tersedia di: https://onlinelibrary.wiley.com/doi/full/10.1002/ijgo.13717.
Hashiguchi M. Temporary cross-clamping of the infrarenal abdominal aorta during cesarean hysterectomy to control operative blood loss. Surg J. 2021; 7(Suppl 1):S7-S10.
Chou MM, Chen MJ, Su HW, Chan CW, Kung HF, Tseng JJ, et al. Vascular control by infrarenal aortic cross-clamping in placenta accreta spectrum disorders: description of technique. BJOG. 2021;128(6):1030–34.
Joshi VM, Otiv SR, Sovani YB, Kulat PK. Aortic clamping for limiting blood loss at cesarean hysterectomy for placenta percreta: A case series. Int J Gynecol Obstet. 2022;157(2):289–95.
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Jurnal Anestesi Obstetri Indonesia
