Management of massive hemorrhage in pregnant women with placenta previa

Abstract

Patients with placenta previa are at risk for intra- and postpartum massive blood loss as well as increased risk of placenta accreta, a type of abnormal placental implantation. This condition can lead to serious obstetric complications, including maternal mortality and morbidity. The risk factors for previa include prior cesarean section, multiparity, advanced maternal age, prior placenta previa history, prior uterine surgery, and smoking. The prevalence of previa parturients has increased due to the rising rates of cesarean section and advanced maternal age. For these reasons, we need to identify the risk factors for previa and identify adequate management strategies to respond to blood loss during surgery. This review evaluated the diagnosis of placenta previa and placenta accreta and assessed the risk factors for previa-associated bleeding prior to cesarean section. We then presented intraoperative anesthetic management and other interventions to control bleeding in patients with previa expected to experience massive hemorrhage and require transfusion.

Keywords: Balloon occlusion; Cesarean section; Obstetrical anesthesia; Placenta accreta; Placenta previa; Postpartum hemorrhage; Uterine artery embolization.

Fig. 1.

Preoperative ultrasonography findings of a patient with anterior placenta previa indicating suspicious lacunar space, sponge-like findings in the cervix wall, and lack of retroplacental clear zone.

Fig. 2.

Preoperative magnetic resonance imaging of a patient with anterior placenta previa and placenta accreta suggesting placenta adhering to the bladder wall (arrow).