Hypervolemic Hemodilution as a Management During Predicted Massive Bleeding Sectio Caesarea in Placenta Accreta Patient

Fanniyah Fanniyah, Ruddi Hartono


Background: Placenta accreta represent one of the most morbidity condition in modern obstetrics, with high rates of hemorrhage, hysterectomy and intensive care unit admission. Alternative management during intraoperative bleeding is haemodilution. There are two techniques in hemodilution, autonomic normovolemic hemodilution (ANH) and hypervolemic hemodilution.

Case: A gravida patient with ASA 2 physical status with a suspected placenta accreta was planned for a sectio caesarea. To anticipate bleeding, hypervolemic hemodilution was conducted. Hemodilution was performed with a total fluid of 2000cc. Total bleeding during surgery is 3500 cc. A close monitoring of haemoglobin (Hb) and haematocrit (Hct) was conducted. The initial Hb and Hct were 9.9 mg/dl and 29.8%, respectively. The Hb and Hct results post-haemodilution were 5.7 and 17.1, respectively. The postoperative Hb and Hct results were 5.4 mg/dl and 16.6%, respectively. The patient was given a blood transfusion of 450 cc PRC (packed red cells).. The patient was observed in the ICU for 24 hours postoperatively and was subsequently transferred to the ward.   Hemodilution, in this case, was proven to be effective based on the post-hemodilution and post-haemorrhage Hb and Hct results. The total bleeding was 3500 cc, and there was a reduction of Hb from 5.7 to 5.4 and haematocrit from 17.7% to 16.6%. 

Conclusion: Due to the hemodilution, not only the red blood cells were lost, but also the hemodilution fluids. Hemodilution may be an alternative management during intraoperative haemorrhage. However, the anticipation and effect that might arise from hemodilution should be considered. 


Keywords: Accreta, Hemodilution, Hypervolemic hemodilution, massive hemorrhage. 


accreta; hemodilution; hypervolemic hemodilution; massive hemorrhage;

Full Text:



Carusi D. Placenta accreta: Epidemiology and risk factors In: Placenta Accreta Syndrome CRC Press; 2017:1-12

Takeda S, Takeda J, Makino S. Cesarean section for placenta previa and placenta previa accreta spectrum. The Surgery Journal. 2020;6(S 02): S110-S121

Morgan GE, Mikhail MS. Morgan & Mikhail's Clinical Anesthesiology. McGraw-Hill Education; 2018

Rajuddin R, Roziana R, Munawar M, Iqbal M. Management Placenta Percreta Succesfully With Total Abdominal Hysterectomy A Case Review. AVERROUS: Jurnal Kedokteran dan Kesehatan Malikussaleh. 2019;5(1):52-62

Martinez JCD, Martinez AMD, Villarejo GP. Abstract PR017: Limits of Hypervolemic Hemodilution in Jehovah'S Witnesses Patients. Anesthesia & Analgesia. 2016;123(3S):29

Wu J, Zhang Z. The effects of acute hypervolemic hemodilution and conventional infusion in laparoscopic radical prostatectomy patients. American Journal of Translational Research.2021;13(7):7866

Guo J, Yuan X, Zhou X, Jin X. Pharmacokinetics and pharmacodynamics of cisatracurium in patients undergoing surgery with two hemodilution methods. Journal of clinical anesthesia. 2017;38:75-80

Elnaghy KM, Nasr I-E, Kamal EM. Acute hypervolemic hemodilution combined with controlled hypotension to minimize blood loss during operations of spine fusion: remifentanil versus magnesium sulfate. Ain-Shams Journal of Anesthesiology. 2021;13(1):1-10

DOI: http://dx.doi.org/10.21776/ub.jap.2022.003.01.04


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.