Penggunaan Skor Indeks Plasenta Akreta (IPA) sebagai Prediktor Manajemen Perioperatif Seksio Sesarea Pasien dengan Plasenta Previa Totalis Suspek Akreta

Indonesia

  • Dadik Wahyu Wijaya Faculty of Medicine Universitas Sumatera Utara Medan
  • Yusmein Uyun Faculty of Medicine Universitas Gadjah Mada Yogyakarta
  • Sri Rahardjo Faculty of Medicine Universitas Gadjah Mada Yogyakarta
Keywords: histerektomi, indeks plasenta akreta, perioperatif, plasenta akreta, plasenta previa, seksio sesarea, cesarean section, hysterectomy, perioperative, placenta previa, placenta accreta index

Abstract

Plasenta akreta adalah suatu kondisi kehamilan yang serius yang disebabkan oleh kelainan perlekatan plasenta yang membutuhkan perhatian khusus secara perioperatif. Kasus ini menggambarkan manajemen anestesi yang sesuai untuk seksio sesarea dan total abdominal histerektomi karena  plasenta previa totalis dugaan akreta. Seorang wanita berusia 33 tahun dipersiapkan untuk menjalani seksio sesarea elektif dan histerektomi total akibat plasenta previa totalis dengan kecurigaan tinggi terhadap akreta berdasarkan Indeks Skor Plasenta Akreta (IPA). Pemeriksaan penunjang dilakukan oleh dokter kandungan untuk mengkonfirmasi diagnosis. Pada pasien ini dilakukan tindakan anestesi umum untuk prosedur operasinya. Kadar hemoglobin pasien sebelum operasi adalah 9,1 g / dl. Dengan total perdarahan selama operasi adalah 2000 mL. Estimasi kehilangan darah yang ditolerir untuk pasien ini adalah 633 ml. Pasien menerima transfusi 2(dua) kantong darah PRC dan 1(satu) kantong darah WB. Kadar hemoglobin setelah transfusi adalah 8,9 g / dL Pasien dipulangkan dari rumah sakit dalam kondisi stabil setelah dirawat selama 3 hari diruangan. Sebagai kesimpulan, evaluasi dan persiapan perioperatif dan kolaborasi multidisiplin adalah kunci keberhasilan manajemen pasien dengan plasenta previa suspek akreta.

 

The Use of Placenta Acreta Index (PAI) Score as Perioperative Management Predictor of Sectio Caesarean Patient with

Total Placenta Previa Suspected Acreta

Placenta accreta is a serious pregnancy condition caused by disorder of placenta attachment that needs a special consideration perioperatively. This case was described the propriate anesthesia management for Cesarean Section and Total Abdominal Hysterectomy due to Total Placenta Previa suspected Accreta. A 33 years old woman considered for elective cesarean section and hysterectomy due to Total Placenta Previa with high suspicion of Accreta according to Placenta Accreta Index (PAI) Score. Supportive examination was done by the obstetrician to confirm the diagnosis. She underwent general anesthesia for the surgery. Patient’s hemoglobin level before surgery was 9.1 g/dL. With total bleeding during the surgery is 2000 mL. The allowable blood loss for the patient is 633 mL. Patient was transfused with 2 bags of PRC and 1 bag of Whole Blood. The hemoglobin level after transfusion was 8.9 g/dL She was discharged from the hospital in stable condition after being treated for 3 days at normal ward. As conclusion, perioperative evaluation and preparations and multidiscipline collaboration are the key for successful management for patient with Placenta previa/accreta

 

Author Biographies

Dadik Wahyu Wijaya, Faculty of Medicine Universitas Sumatera Utara Medan

Department Anesthesiology and Intensive Care H. Adam Malik General Hospital Medan

Yusmein Uyun, Faculty of Medicine Universitas Gadjah Mada Yogyakarta

Departement Anesthesiology and Intensive Care General Hospital Dr. Sardjito Yogyakarta

Sri Rahardjo, Faculty of Medicine Universitas Gadjah Mada Yogyakarta

Departement Anesthesiology and Intensive Care General Hospital Dr. Sardjito Yogyakarta

References

Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ERM et al. Obstetrics: Normal and Problem Pregnancies, 7th Ed. 2017. Philadelpia, Elsevier.

Petersen OMF, Debra SH, Vijay VJ. Handbook of Placental Pathology, 2nd ed. 2006. Boca Raton, Taylor & Francis.

Sivasankar C. Perioperative management of undiagnosed placenta percreta: case report and management strategies. Int J Womens Health. 2012;4:451–54.

Silver R. Placenta Accreta Syndrome. 2017. Boca Raton, Taylor & Francis.

Hudon L, Belfort MA, Broome DR. Diagnosis and management of placenta percreta: a review. Obstet Gynecol Surv. 1998;53(8):509–17.

Committee on Obstetric Practice. Committee opinion no. 529: placenta accreta. Obstet Gynecol. 2012;120(1):207–11.

Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM et al. Williams Obstetrics, 24th Ed. New York, McGraw Hill, 2014; 36–40.

Rac MW, Dashe JS, Wells CE, Moschos E, McIntire DD, Twickler DM. Ultrasound predictors of placental invasion: the Placenta Accreta Index. Am J Obstet Gynecol. 2015;212(3):343.

Jauniaux E, Jurkovic D. Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta. 2012;33(4):244–51.

Binici O, Büyükfırat E. Anesthesia for Cesarean Section in Parturients with Abnormal Placentation: A Retrospective Study. Cureus. 2019;11(6).

Orbach-Zinger S, Weiniger CF, Aviram A, et al. Anesthesia management of complete versus incomplete placenta previa: a retrospective cohort study. J Matern Fetal Neonatal Med. 2018;31(9):117176.

Berkley EM, Abuhamad AZ. Prenatal diagnosis of placenta accreta: is sonography all we need?. J Ultrasound Med. 2013;32(8):1345–50.

Fauzan, Wulan AI, Tiarma UP, Febriansyah D, Bintari P, et al. USG Untuk Deteksi Plasenta Akreta. CDK. 2017;4(8):586–90.

Abdulsalam RAH, Mohammed EDA, Amr MEH, & Marwa L. 2017. Histological and Histopathological Study of Lower Uterine Segment After Previous Cesarean Section and Placenta Accreta. International Journal of Basic and Applied Science. 6(4):90–101.

Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int J Gynaecol Obstet. 2018;140(3):265–73.

Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018;218(1):75–87.

Publications Committee, Society for Maternal-Fetal Medicine, Belfort MA. Placenta accreta. Am J Obstet Gynecol. 2010;203(5):430–39.

Paech MJ, Scott KL, Clavisi O, Chua S, McDonnell N; ANZCA Trials Group. A prospective study of awareness and recall associated with general anaesthesia for caesarean section. Int J Obstet Anesth. 2008;17(4):298–303.

Published
2020-09-17
Section
Case Report