Saint Joseph University, Beirut, Lebanon.
Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, P.O. Box: 116-5137, Beirut, Lebanon.
BMC Pregnancy Childbirth. 2020 Feb 28;20(1):135. doi: 10.1186/s12884-020-2817-2.
Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality.
This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient's death.
This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.
胎盘植入与高出血风险相关，并可能并发致命性血栓栓塞事件。为降低发病率和死亡率，必须让多学科团队参与这些患者的治疗。
本文报告了一位 22 岁胎盘植入患者的病例，该患者因分娩被转诊至我们的三级医疗中心。在成功进行剖宫产子宫切除术数小时后，患者发生了肺栓塞和心脏骤停。重症监护病房（ICU）进行的经胸超声心动图显示右心室有血栓。心脏复苏后，患者接受了紧急开胸手术和肺动脉血栓切除术；从肺动脉中取出了许多血栓。体外循环脱机后，术中经食管心脏超声使医疗团队能够检测到右心房和右心室的新的游离漂浮血栓，并随后进行了取栓术，防止了患者的死亡。
该病例强调了多学科团队在治疗可能并发大量和致命性血栓栓塞事件的高危产科病例中的作用。术中经胸超声心动图的使用有助于发现新的血栓，并指导麻醉师进行术中监测。
