Anesthetic Approach to Placenta Previa with Associated Bladder Rupture: A Case Report
DOI:
https://doi.org/10.24843/nqk01d22Kata Kunci:
Anesthetic Management, Bladder Rupture, Caesarean Hysterectomy, Placenta Accreta Spectrum, Placenta PreviaAbstrak
This case report outlines the anesthetic management of total placenta previa with high-risk features of placenta accreta spectrum (PAS) complicated by bladder rupture, representing a rare but clinically significant form of invasive placentation. A 29-year-old G2P1001 at 35+3 weeks’ gestation presented with recurrent antepartum bleeding and ultrasonographic features consistent with PAS, including grade III lacunae, bridging vessels, severe myometrial thinning, and a Placenta Accreta Indeks (PAI) score of 6. Spinal anesthesia was initiated for delivery, followed by a controlled conversion to general anesthesia to facilitate hysterectomy, two-layer bladder repair, ureteral reconstruction, and Double-J stent placement. Hemodynamic stability was maintaned using tranexamic acid, colloid co-loading, invasive arterial monitoring, and norepinephrine titration. An estimated blood loss of 2,300 mL was managed with targeted transfusion, resulting in favourable maternal recovery and neonatal outcomes (Apgar 7 and 9). This case underscores the importance of early PAS recognition, structured anesthetic planning, and coordinated multidisciplinary care, supporting the benefit of a staged neuraxial-to-general anesthesia strategy in complex PAS with urologic involvement.
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Referensi
1. Vuppuluri V, Thangaswamy S. Anaesthetic Management of a Patient with Placenta Previa (PP) - A Case Study. Texila International Journal of Public Health. 2024 Sep 1;12(3).
2. Fan D, Rao J, Lin D, Zhang H, Zhou Z, Chen G, et al. Anesthetic management in cesarean delivery of women with placenta previa: a retrospective cohort study. BMC Anesthesiol. 2021 Dec;21(1):247.
3. Smith ZL, Sehgal SS, Van Arsdalen KN, Goldstein IS. Placenta Percreta With Invasion into the Urinary Bladder. Urol Case Rep. 2014 Jan;2(1):31–2.
4. Zhao H, Zhao X, Liu C, Tao Y, Zhou Y. Bladder Bleeding Due to Placenta Percreta: Report of Four Cases and Management Discussion. Matern-Fetal Med. 2021 Oct;3(4):285–91.
5. Jasinski T, Remesz A, Resko R, Budynko A, Majdylo K. Anesthetic Management for Patients with Placenta Accreta Spectrum: A Scoping Review. J Clin Med. 2025 July 4;14(13):4738.
6. Bartels HC, Walsh D, Nieto‐Calvache AJ, Lalor J, Terlezzi K, Cooney N, et al. Anesthesia and postpartum pain management for placenta accreta spectrum: The healthcare provider perspective. Int J Gynecol Obstet. 2024 Mar;164(3):964–70.
7. Department of Anesthesiology and Intensive Therapy, RSUD Dr. Moewardi Surakarta, Medical Faculty Sebelas Maret University, Indonesia Indonesia, Ihsaniar A, Anggoro P, Department of Anesthesiology and Intensive Therapy, RSUD Dr. Moewardi Surakarta, Medical Faculty Sebelas Maret University, Indonesia Indonesia. Epidural Anesthesia Management in Cesarean Section with Placenta Accreta. J Anaesth Pain. 2022 Sept;3(3):57–60.
8. Metogo JAM, Nana TN, Ngongheh BA, Nyuydzefon EB, Adjahoung CA, Tochie JN, et al. General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study. BMC Anesthesiol. 2021 Dec;21(1):68.
9. Taylor NJ, Russell R. Anaesthesia for abnormally invasive placenta: a single-institution case series. Int J Obstet Anesth. 2017 May;30:10–5.
10. Reale SC, Farber MK. Management of patients with suspected placenta accreta spectrum. BJA Educ. 2022 Feb;22(2):43–51.
11. Shuai X, Gao C, Zhang H, Zhang T, Li H, Yan Y, et al. Bladder involvement in placenta accreta spectrum disorders: 2D US combined with the 3D crystal Vue and MRI comparative analysis. BMC Pregnancy Childbirth. 2024 Nov 26;24(1):788.
12. Liang S, Lyu J, Shi H, Zhao Y, Chong Y, Hou X, et al. Management strategy for urologic morbidity in surgery of placenta accreta spectrum: stents or catheters? J Matern Fetal Neonatal Med. 2023 Dec 15;36(2):2232076.
13. Teymoordash SN, Ghahari S, Movahedi S, Safkhani Z, Gholizadeh M, Khalili S. Managing Placenta Accreta Spectrum: A case report on combining conservative care with uterine angioembolization. Int J Surg Case Rep. 2024 June;119:109774.
14. Shamshirsaz AA, Fox KA, Erfani H, Clark SL, Salmanian B, Baker BW, et al. Multidisciplinary team learning in the management of the morbidly adherent placenta: outcome improvements over time. Am J Obstet Gynecol. 2017 June;216(6):612.e1-612.e5.
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De-identified patient data from this case report will be made available upon reasonable request to the corresponding author following publication, subject to institutional data-sharing policies and ethics approval.
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Hak Cipta (c) 2025 Made Bagus Cahya Maha Putra, IGAG Utara Hartawan, DA Mas Shintya Dewi (Author)
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