Epidural Anesthesia Management in Cesarean Section with Placenta Accreta

Abstract

Background: In pregnant women, the spectrum of placenta accreta is considered a high risk syndrome. Placenta accreta is responsible for 7-10% of all maternal deaths worldwide. This study reports on a patient with placenta accreta who underwent a cesarean section using epidural anesthesia.

Case: A 30-year-old woman (Gravida: 3, Abortus: 1, Partus: 1) with a gestational age of 8 months came to the hospital.  with 8 months of gestation was diagnosed with antepartum hemorrhage et causa placenta previa totalis morbidly adherent placenta high risk with planned elective cesarean section with bilateral tubectomy to hysterectomy, Double J (DJ) stent, Ballooning using epidural anesthesia with physical American Society of Anesthesiologists (ASA) II status. Local anesthetic with 2% lidocaine 2 ml, 12 ml of 0.5% bupivacaine given in incremental doses of 4 ml every 5 minutes while monitoring the patient's hemodynamics. Intraoperative drugs consist of intravenous (IV) dexamethasone 5 mg IV, ondansetron 8 mg IV, tranexamic acid 1 gram, paracetamol 1 gram IV, bupivacaine 0.5% 3ml every 1 hour via an epidural catheter. Maintenance using O₂ 3 lpm. The operation lasted 450 minutes, with stable outcome both maternal and fetal.

Conclusion: Anesthesia management in patients with bleeding during labor is very important. In this case, epidural anesthesia provide a good outcome in maternal and fetal after cesarean section in placenta accreta patient.