Vascular clamps in perimortem caesarean delivery in parturients with placenta accreta spectrum: Case report and literature review

Sandipika Dogra; Kameswari Surampadi; Manokanth D A Madapu; Sunil T Pandya

doi:10.4103/JOACC.JOACC_33_22

CASE REPORT

Year : 2023 | Volume : 13 | Issue : 1 | Page : 94-98

Vascular clamps in perimortem caesarean delivery in parturients with placenta accreta spectrum: Case report and literature review

Sandipika Dogra¹, Kameswari Surampadi², Manokanth D A Madapu³, Sunil T Pandya⁴
¹ Department of Anaesthesia, Pain Medicine and Obstetric Critical Care Fernandez Hospitals (A Unit of Fernandez Foundation), Hyderabad, India
² Chief of Gynaecology, Fernandez Hospitals (A Unit of Fernandez Foundation), Hyderabad, India
³ Fellowship in Obstetric Anaesthesia (MGH, USA), Lead Consultant, Fernandez Hospital (A Unit of Fernandez Foundation), Unit II, Hyderabad, India
⁴ Department of Anaesthesia, Pain Medicine and Obstetric Critical Care Fernandez Hospitals (A Unit of Fernandez Foundation); Cardiac and Neuro Anaesthesia, Post Doctorate Fellow-Obstetric Anaesthesia, Chief of Anaesthesia, Peri-Operative Medicine and Critical Care, AIG Hospitals; Director, PACCS Health Care Pvt Ltd., Hyderabad, India

Correspondence Address:
Dr. Sunil T Pandya
Chief, Department of Anaesthesia, Peri-operative Medicine and Critical Care, AIG Hospitals, Hyderabad, Consultant, Department of Anaesthesia, Pain Medicine and Obstetric Critical Care, Fernandez Hospitals (A Unit of Fernandez Foundation), Founder Director, PACCS Health Care Pvt. Ltd., Hyderabad
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/JOACC.JOACC_33_22

The increasing incidence of caesarean section (CS) increases the risk for placenta accrete spectrum (PAS) conditions in pregnancy. The aortic vascular clamps can be used in low resource settings to minimise major obstetric haemorrhage in a parturient with PAS. We report one case of major obstetric haemorrhage attributable to PAS and other cases that had the potential to bleed post-return of spontaneous circulation (ROSC). The first case had torrential bleed following classical CS done for percreta leading to severe haemodynamic instability and a near arrest situation despite standard protocolised management. As a last resort to control catastrophic bleeding, the aortic vascular clamp was used to avert an imminent cardiac arrest, which successfully lead to effective resuscitation and later uneventful recovery. The second case was a perimortem caesarean delivery in a diagnosed case of placenta percreta where we contemplated to use this clamp during resuscitative hysterotomy [Perimortem caesarean delivery (PMCD)] as its usage is likely to confer haemodynamic stability post-ROSC bleeding. However, the patient could not be revived. We have found that in addition to anaesthetic and major haemorrhage management skills in tackling a massive obstetric haemorrhage, the availability of trained surgical teams for controlling ongoing haemorrhage is crucial for effective resuscitation. Using aortic and common iliac vascular clamps as a damage control measure also plays a very important role in controlling catastrophic maternal haemorrhage. With the growing incidence of PAS and uncontrolled bleeding in these parturients, the skilled anaesthetic and resuscitative skills of anaesthesiologists are futile if haemorrhage is not controlled. We found that the availability and use of the vascular clamps at the time of PMCD are very useful to control bleeding and help in effective resuscitation. Its use has a short learning curve and the personnel can be trained easily.

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