Case scenario: perioperative management of a multigravida at 34-week gestation diagnosed with abnormal placentation.

摘要

PERIPARTUM hemorrhage is responsible for 150,000 maternal deaths worldwide each year. Although the risk of maternal death has decreased over the preceding century, there has recently been a concerning suggestion of an increase in the overall incidence of hemorrhage. Despite multiple advances in medical and surgical care, a steady rise in hemorrhage has been noted within the developed world. Statistically significant increases in the incidence of maternal hemorrhage have been reported in retrospective studies in Canada (from 4.1% to 5.1%) and Australia (from 4.9% to 6.3%). Similarly, there was an increase in maternal deaths secondary to hemorrhage in the United Kingdom during the years 2000- 2002. This new uptick in the rate of peripar-tum hemorrhage has been attributed to increasing maternal age, multiple gestations, and the rise in the rate of cesarean sections. The most common cause of postpartum hemorrhage remains uterine atony. Disorders of placentation can be associated with either uterine atony or retained placenta. Importantly, in the developed world abnormal placentation is commonly diagnosed before delivery; with proper medical management and multidisciplinary planning, the associated morbidity and mortality can be minimized.