Resuscitation of Penetrating Placental Hemorrhage by Massive Transfusion

Special Article – Surgery Case Reports

Austin J Surg. 2019; 6(15): 1201.

Resuscitation of Penetrating Placental Hemorrhage by Massive Transfusion

Guangyi L#, Hengjing Z#, Mingyong H, Min J, Zuofeng W, Yanhong L and Shan O*

Department of Anesthesiology, Chengdu First People’s Hospital, China

#Lai Guangyi and Zou Hengjing contributed equally to this study

*Corresponding author: Ou Shan, Department of Anesthesiology, Chengdu First People’s Hospital, No.18 Wanxiang North Road, Chengdu 610041, China

Received: June 17, 2019; Accepted: July 23, 2019; Published: July 30, 2019


Background: Placenta implantation is one of the common causes of obstetric hemorrhage. Prior to the effective hemostasis by obstetricians, the main measures for treating obstetric hemorrhage are blood transfusion and prevention of Disseminated Intravascular Coagulation (DIC). How to reasonably use blood products to maintain effective circulation and coagulation function is the key and difficult point of treatment.

Method: We reported one patient with central placenta previa combined with penetrating placenta implanted into the bladder, with total blood loss exceeding 10,000 ml during the operation.

Results: We successfully saved the life of the patient and treated DIC by autologous blood transfusion and transfusion of blood products.

Conclusion: In the process of treating penetrating placental hemorrhage, blood products, especially plasma, should be transfused as soon as possible to delay the occurrence and development of DIC. In addition, autologous blood recovery technology is used to reduce the transfusion volume of allogeneic blood and to save more time for salvage.

Keywords: Obstetric hemorrhage; Penetrating placenta; Autologous blood transfusion; Massive transfusion


DIC: Disseminated Intravascular Coagulation; Hb: Hemoglobin; Hct: Hematokrit; Plt: Blood Platelet; Fbg: Fibrinogen; PT: Prothrombin Time; APTT: Activated Partial Thromboplastin time; Glu: Blood Glucose; Lac: Lactic acid; BE: Base Excess; AG: Anion Gap

Case Presentation

The patient was a Chinese female, 31-year-old, admitted to the hospital due to “menopause for 34 weeks + 1 day, vaginal bleeding with lower abdomen tightness for 2 hours”. Admitting diagnosis: (1) dangerous placenta previa with hemorrhage; (2) placenta implantation: penetrating placenta implanted in the bladder; (3) G6P2+3 34+6 weeks’ intrauterine pregnancy LS live-birth threatened premature labor; (4) scarred uterus; (5) abnormal thyroid function during pregnancy. Physical examination showed symmetrical breathing of two lungs, clear breath sounds, regular heart rhythm, no heart murmurs, abdominal circumference of 95 cm, fundal height of 32 cm, LS of the fetus, fetal heart rate of 135 beats/min, irregular uterine contraction, with no vulva abnormality. Color Doppler ultrasound suggested placenta thickening, placenta implanted the anterior wall of the bladder, placenta previa, considering placenta implantation because of the placenta echo changes. MRI indicated total placenta previa, unclear border between the placenta and local uterine, and possibility of local adhesions of placenta and placenta implantation (Figure 1). Preoperative laboratory results: hemoglobin (Hb) 104 g/L, hematokrit (Hct) 30.1%, blood platelet (Plt) 116×109/L, fibrinogen (Fbg) 3.044, prothrombin time (PT) 10.1 s, activated partial thromboplastin time (APTT) 25.3 s. The patient refused abdominal aortic balloon occlusion and the elective cesarean section was arranged. Blood group screening and cross blood matching were performed before surgery, and 8 U of red blood cell suspension and 300 ml of fresh frozen plasma were prepared.

Citation: Guangyi L, Hengjing Z, Mingyong H, Min J, Zuofeng W, Yanhong L, et al. Resuscitation of Penetrating Placental Hemorrhage by Massive Transfusion. Austin J Surg. 2019; 6(15): 1201.