| I have WHAT??? WHY ME??? | A Picture Says 1,000 Words | "The best laid plans of mice and men often go awry" | "I could hear blood dripping on the floor." |
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What is placenta accreta?
This is the general term used when part of the placenta invades and is inseparable from the uterine wall.
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What are anesthesia, gynecologic oncology, and neonatology? Also consider interventional radiology and urology.
These clinical services should be consulted prior to planned delivery.
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What is 300 mL and about 1 gram?
This is the volume of one unit of packed RBCs and transfusion of one unit will increase the Hemoglobin by about _____ g.
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What are the myometrium and uterine serosa, and occasionally adjacent organs such as the bladder (percreta) vs. only the myometrium (increta)?
These layers of the uterus are involved with a placenta percreta vs. these layers with a placenta increta.
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What is a vertical midline incision?
Your patient is known to have a placenta percreta with significant involvement of the lower uterine segment with bulging to the left lateral side and likely involvement of the bladder. Her BMI is normal. This is the optimal type of surgical incision to
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What are fresh frozen plasma and cryoprecipitate, and cryoprecipitate contains the highest concentrations?
These two blood products include fibrinogen, but this blood product contains the highest concentration of fibrinogen.
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What are prior uterine surgery, placenta previa, advanced maternal age, and multiparty (G3 or more)?
These are 4 risk factors for placenta accreta, based on your reading.
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What is 34 weeks?
The timing of delivery is controversial, but is generally recommended to occur by this gestational age.
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What are 4 units of uncrossmatched PRBCs and 2 units of FFP, and trauma literature suggests improved outcomes with 1:1?
The GRU Blood Bank's massive transfusion protocol includes these blood products at a 2:1 ratio, but based on trauma literature, this is the suggested ratio at which to replace blood products.
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What are prior c-section, placenta previa, and multiparty?
Women with these three risk factors are at the greatest risk of placenta accreta, up to 67%.
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What is placement of epidural catheter to be dosed in IR (if used) or in OR for preoperative ureteral stent placement, then general anesthesia immediately before incision (after prepped and draped)?
This is your ideal plan for anesthesia to minimize anesthesia effects to fetus.
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What is normal saline, as large volumes of normal saline may contribute to the development of hyperchloremic acidosis?
Volume expansion to prevent hypovolemic shock is done with a ratio of 3:1 crystalloid to colloid. You should limit the amount of this type of fluid used to prevent this electrolyte abnormality.
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What are previous myomectomy, endometrial defects due to vigorous curettage resulting in Asherman syndrome, submucousal leiomyomas, thermal ablation, and uterine artery embolization.
Besides the 4 most common risk factors, the ACOG Committee Opinion mentions these less common risk factors for placenta accreta (name at least 2).
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What is femoral artery > becomes external iliac artery > to common iliac artery > aorta > cross to contralateral common iliac artery > internal iliac artery > anterior division of the hypogastric artery > uterine artery?
You opt to have Interventional Radiology place balloons in the uterine arteries to be inflated after delivery of the neonate to reduce uterine blood flow. This is the path that the catheters take from initial access of the femoral artery to the uterine a
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What is hypocalcemia due to citrate toxicity? Citrate, an additive to packed RBCs to prevent coagulation, binds to ionized calcium. Subsequent hypocalcemia can result in cardiac arrhythmias and exacerbation of bleeding.
This is the most frequent metabolic abnormality associated with massive blood transfusion.
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