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Anesthesiology and Intensive Therapy Program, Medicine FacultyBrawijaya University, Malang Indonesia Jl. Jaksa Agung Suprapto no.2, Malang, Indonesia
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Journal of Anaesthesia and Pain
Published by Universitas Brawijaya
ISSN : 27223167     EISSN : 27223205     DOI : http://dx.doi.org/10.21776/ub.jap
Core Subject : Health,
Health Professions Medicine & Pharmacology
Journal of Anaesthesia and Pain is a peer-reviewed and open-access journal that focuses on anesthesia and pain. Journal of Anaesthesia and Pain, published by Anesthesiology and Intensive Therapy Specialist Program of Medicine Faculty, Brawijaya University. This journal publishes original articles, case reports, and reviews. The Journal s mission is to offer the latest scientific information on anesthesiology and pain management by providing a forum for clinical researchers, scientists, clinicians, and other health professionals. This journal publishes three times a year. Subjects suitable for the Journal of Anaesthesia and Pain are all subjects related to anesthesiology and pain management.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 1 Documents
 1 
Search results for , issue "Vol. 6 No. 2 (2025): May" : 1 Documents clear
Anesthesia Management and Intensive Care in Cesarean Section on a Woman with Placenta Accreta with Placenta Accreta Index (PAI) Score of ≥ 6: A Case Report Prasetyo, Denny; Isngadi, Isngadi
Journal of Anaesthesia and Pain Vol. 6 No. 2 (2025): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Placenta accreta spectrum (PAS) is the leading cause of peripartum hysterectomy. PAS often results in massive postpartum haemorrhage, requiring careful perioperative planning and multidisciplinary coordination. This case report aims to discuss the anesthesia management and intensive care provided to a patient who underwent cesarean section (CS) with a placenta accreta index (PAI) score of ≥6.Case: This case involves a 32-year-old multipara with a history of three previous CS. The patient was scheduled for CS due to breech presentation and suspected total placenta previa/accreta with a PAI score of ≥ 6. A combined spinal-epidural (CSE) was chosen as anesthesia management. During surgery, the patient experienced severe bleeding (3,000 mL) with hypotension (blood pressure 81/44 mmHg) and bradycardia (heart rate 60 beats per minute). Central iliac artery balloon occlusion (CIABO) was performed by a radiologist for temporary blood flow occlusion. Resuscitation included 3,000 mL crystalloids, 1,000 mL colloids, and 1,200 mL blood product. A baby girl was delivered (Apgar 7–9). The patient remained stable in the intensive care unit and was transferred to the regular ward the following day.Conclusion: Comprehensive perioperative planning and multidisciplinary coordination in managing PAS are important. Despite severe intraoperative hemorrhage and hemodynamic instability, the use of combined spinal-epidural anesthesia, prompt fluid and blood resuscitation, and intensive monitoring ensured a favorable outcome. Postoperative lactate value and early transfer from the ICU to the regular ward indicate successful management.

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