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- Title
Peri-operative management of hysterostomy in a parturient with complete heart block, placenta accreta and intrauterine death.
- Authors
Rai, Vineya; Shariffuddin, Ina I.; Chan, Yoo K.; Muniandy, Rajesh K.; Wong, Kang K.; Singh, Sukcharanjit
- Abstract
Background Complete heart block in pregnancy has serious implications particularly during the period of delivery. This is more so if the delivery is an operative one as the presence of heart block may produce haemodynamic instability in the intra operative period. We report a unique case of a pregnant mother with complete heart block undergoing hysterostomy, complicated by placenta accreta and intrauterine death. Case report A 37 year old Malaysian Chinese parturient was admitted at 25 weeks gestation following a scan which suggested intrauterine death and placenta accreta. She was diagnosed to have congenital complete heart block after her first delivery eight years previously but a pacemaker was never inserted. These medical conditions make her extremely likely to experience massive bleeding and haemodynamic instability. Among the measures taken to optimise her pre-operatively were the insertion of a temporary intravenous pacemaker and embolization of the uterine arteries to minimize peri-operative blood loss. She successfully underwent surgery under general anesthesia, which was relatively uneventful and was discharged well on the fourth post-operative day. Conclusion Congenital heart block in pregnancies in the presence of potential massive bleeding is best managed by a team, with meticulous pre-operative optimization. Suggested strategies would include insertion of a temporary pacemaker and embolization of the uterine arteries to reduce the risk of the patient getting into life threatening situations.
- Subjects
MALAYSIA; UTERINE surgery; CESAREAN section; CHINESE people; ELECTROCARDIOGRAPHY; HEART block; LABOR complications (Obstetrics); PERINATAL death; PLACENTA diseases; PERIOPERATIVE care
- Publication
BMC Anesthesiology, 2014, Vol 14, Issue 1, p1
- ISSN
1471-2253
- Publication type
Article
- DOI
10.1186/1471-2253-14-49