ANESTHETIC APPROACH TO THE PATIENT WITH PLACENTA PREVIA TOTALIS AND PLACENTA ACREATA; CASE REPORT. Plasenta previa totalis ve plasenta akreatal? gebeye anestezik yakla??m; Olgu sunumu.

摘要

Plasenta accreata is defined as an abnormal adherence of the placenta to the uterine Wall owing to a faulty or an absent decidua basalis. Placenta accreta is further subdivided into placenta accreta vera, increta and percreta, depending on the level of invasion of the uterine wall and surrounding structures. A 32 years old pregnant women was admited to the hospital with trans vaginal bleeding at 31weeks gestational ages (twins). The patient was assigned for spinal anesthesia as she did not accepted general anesthesia. After the completion of anesthesia, cesearian section was performed and twin baby girls were born alive. Surgical findings revealed total closure of internal ostium by dichorionic placenta and invasion of uterus serosa. Theteamwaspreparedforprobable risk of hemorrhage and colloid infusion was administered. During the fluid resusitation Fresh frozen plasma was also given. The hemorrhage could only be controlled by hysterectomy with the informed consent of patients family. Her vital signs were normalized after hemostasis. Here in, we discussed the case and anesthesia in view of the literature. ?ZET Plasenta akreata, desudea bazalisin bozuklu?una yada yoklu?una neden olan, plasentan?n uterus duvar?na anormal ?ekilde yap???kl??? olarak tan?mlan?r. Plasenta akreata, uterusa invazyon seviyelerine ve tabakalar? ?evrelemelerine ba?l? olarak akreata vera, inkreata ve perkreata olmak üzere ü? gruba ayr?l?r. 32 ya??nda 31 haftal?k ikiz gebeli?i olan hasta kanamayla hastanemize ba?vurdu. Hasta uyumak istemedi?i i?in spinal anestezi planland?. Anestezi i?lemi tamamland?ktan sonra sezeryan ba?lat?ld?, iki tane canl? k?z bebek do?umu oldu. Cerrah dikoryonik plasentan?n internal os’u tamamen kapatt???n? ve uterusun serozas?na kadar invaze etti?ini bildirdi. Olas? kanamaya kar?? ekibi uyard? ve hastaya ikinci damar yolundan kolloid s?v? g?nderilmeye ba?land?. Hastan?n kanamas? histerektomi yap?ld?ktan sonra durduruldu ve vital bulgular stabil hale geldi. Operasyon sonras? hasta kanama kontrolü ve vital bulgular a??s?ndan stabil seyretti. Bu yaz?da, olgumuz ve anestezi ?ekli literatür verileri ?????nda de?erlendirildi.