Acute normovolemic hemodilution, intraoperative cell salvage and PulseCO hemodynamic monitoring in a Jehovah's Witness with placenta percreta

C. J. Nagy, A. S. Wheeler, T. L. Archer

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

A Jehovah's Witness who had had four previous cesarean deliveries was referred to our institution for management of a complete placenta previa at 34 weeks of gestation. A subsequent ultrasound scan was suggestive of placenta percreta with bladder involvement. After erythropoietin and iron supplementation, cesarean hysterectomy was performed. Using PulseCO technology for continuous hemodynamic monitoring, preoperative acute normovolemic hemodilution and intraoperative cell salvage were used resulting in a successful cesarean hysterectomy with a 5500-mL estimated blood loss. The PulseCO system provides continuous, real-time hemodynamic data by applying pulse power analysis to the arterial pressure waveform. A bolus of oxytocin given after delivery produced profound hypotension, the hemodynamics of which were elucidated with the PulseCO system. To our knowledge, the combined use of acute normovolemic hemodilution, intraoperative cell salvage and PulseCO hemodynamic monitoring for cesarean hysterectomy has not been reported previously. These techniques may be particularly useful in managing patients who refuse blood products and/or in whom the baseline hemoglobin is suboptimal.

Original languageEnglish (US)
Pages (from-to)159-163
Number of pages5
JournalInternational Journal of Obstetric Anesthesia
Volume17
Issue number2
DOIs
StatePublished - Apr 1 2008

Keywords

  • Acute normovolemic hemodilution
  • Cardiac output
  • Cell salvage
  • Cell saver
  • Cesarean hysterectomy
  • Jehovah's Witness
  • LiDCO
  • Obstetric hemorrhage
  • Oxytocin
  • Placenta percreta
  • Pulse power analysis
  • PulseCO

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Anesthesiology and Pain Medicine

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