Subarachnoid Block Regional Anesthesia for Cesarean Section in Triplet Pregnancy with Premature Rupture of Membranes in the Region - A Case Report
Case Report
DOI:
https://doi.org/10.55175/cdk.v53i04.1850Keywords:
Subarachnoid block regional anesthesia, spinal anesthesia, triplet pregnancy, case report, caesarean sectionAbstract
Introduction: Triplet pregnancy is a high-risk pregnancy for both mother and baby, the risk of complications increases with the number of fetuses and maternal age. Cesarean section is the recommended for triplet or more. Spinal anesthesia with hyperbaric bupivacaine and an opioid adjuvant is the most popular neuraxial anesthesia for cesarean section and has been used safely in twin, triplet, and quadruplet deliveries. Case: A woman, 34 years old, G5P4A0 gravida preterm triplet result of insemination, and premature rupture of membranes. Weight 70 kg, height 160 cm, Mallampati 2, blood pressure 135/84 mmHg, pulse rate 140 x/minute, temperature 38.80C, SpO2 100% with binasal cannula. The patient underwent cesarean section with subarachnoid block regional anesthesia using hyperbaric bupivacaine and opioid adjuvant. Discussion: This case demonstrates that preterm premature rupture of membranes is a high-risk condition requiring comprehensive management, including the administration of antibiotics and corticosteroids, as well as the selection of an anesthetic technique that is safe for both the mother and the fetus. The use of spinal anesthesia with a combination of bupivacaine, morphine, and fentanyl provides effective analgesia, although vigilance regarding hypotension and opioid side effects remains necessary. Conclusion: Overall, appropriate management resulted in stable maternal outcomes with good neonatal conditions, as evidenced by satisfactory APGAR scores, despite the low birth weight.
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Bisri DY, Bisri T. Pengelolaan anestesi untuk seksio sesarea kehamilan triplet dengan skor LAS. J Anestesi Obstet Indones [Internet].
;4(1):35–42. https://doi.org/10.47507/obstetri.v4i1.56.
Tesemma MG, Yadeta MT. Case report dizygotic dichorionic triamniotic triplet pregnancy delivered at full term: an out of box presentation of triplet — a case report from Ethiopia. Case Rep Obs Gynecol [Internet]. 2018;2018(Article ID 5760147):3. https://doi.org/10.1155/2018/5760147.
Claverol BM, Minaya MR, Moreno IA, Tizon SG, Recarte PP, Alvarez-Mon M, et al. Maternal, perinatal and neonatal outcomes of triplet
pregnancies according to chorionicity: a systematic review of the literature and meta-analysis. J Clin Med. 2022;11(7):1871. doi: 10.3390/
jcm11071871.
NICE Guideline. Twin and triplet pregnancy [Internet]. London: National Institute for Health and Care Excellence (NICE); 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546070/.
Lappen JR, Hackney DN, Bailit JL. Maternal and neonatal outcomes of attempted vaginal compared with planned cesarean delivery in triplet gestations. Am J Obstet Gynecol. 2016;215(4):493.e1−493.e6. doi: 10.1016/j.ajog.2016.04.054.
Farrer JR, Peralta FM. Anaesthesia for the parturient with multiple gestations. BJA Educ. 2022;22(8):306–11. https://doi.org/10.1016/j.
bjae.2022.02.008.
Almira DN. Prevalensi kejadian post operstive nausea and vomiting (PONV) pada pasien sectio caesarea yang menggunakan anestesi spinal di RSIA Sitti Khadijah 1 periode Januari 2020 [Internet]. 2020. Available from: https://repository.unhas.ac.id/id/eprint/1736/4/C011171333_skripsi.pdf.
Perkumpulan Obstetri dan Ginekologi Indonesia Himpunan Kedokteran Feto Maternal. Ketuban pecah dini [Internet]. 2016. Available from: https://www.pogi.or.id/wp-content/uploads/download-manager-files/PNPK-KPD 2016.pdf.
Andalas M, Maharani CR, Endrawan ER, Florean MR, Zulfahmi Z. Ketuban pecah dini dan tatalaksananya. J Kedokt Syiah Kuala. 2019;19:188–92. https://doi.org/10.24815/jks.v19i3.18119.
Rasti SD, Rochmanti M, Primariawan RY. Cefotaxime vs ceftriaxone for the prolongation of latency period in preterm premature rupture of membranes. Int Arab J Antimicrob Agents. 2020;10(1):1–9. doi: 10.3823/839.
Huntari H, Purwakanthi A, Kusdiyah E. Pengaruh penggunaan antibiotik profilaksis dengan lama rawat inap pada pasien seksio sesarea. JMJ. 2020;8(2):172–9. https://doi.org/10.22437/jmj.v8i2.10931.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 171: management of preterm labor. Obstet Gynecol. 2016 Oct;128(4):e155−64. doi: 10.1097/AOG.0000000000001711.
World Health Organization. WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes [Internet]. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/9789240057296.
Gunawan I, Nofriyadi T. The use of dexamathasone in women with preterm premature rupture of membranes: an evidence-based case report. Jambi Med J. 2021;(9(3)):262–9. https://doi.org/10.22437/jmj.v9i3.12230.
Apsari RKF, Suryono B, Shinta S. Manajemen anestesi pada pasien seksio sesarea primigravida dengan glioblastoma multiforme. J Anestesi Obstet Indones. 2020;2(1):35–43. https://doi.org/10.47507/obstetri.v2i1.32.
Soepraptomo R. Regional anestesi subarachnoid block pada wanita 34 tahun G2P1A0 hamil preterm, pre eklamsia berat, ketuban pecah dini 18 jam, pro seksio sesaria dengan status fisik ASA II E. J Komplikasi Anestesi. 2020;7(2):37−42. https://doi.org/10.22146/jka.v7i2.7455.
Nuryawan I, Suryono B, Rahardjo S. Manajemen anestesi pada seksio sesarea pasien dengan HIV (human immunodeficiency virus). J Anestesi Obstet Indones. 2020;2(1):24–34. https://doi.org/10.47507/obstetri.v2i1.31.
Prayanangga FK, Nilasari D. Enhanced recovery after cesarean surgery (ERACS): evidence-based case report. J Anestesiol Indones.
;14(3):274–87. https://doi.org/10.14710/jai.v0i0.50022.
Bollag L, Lim G, Sultan P, Habib AS, Landau R, Zakowski M, et al. Society for obstetric anesthesia and perinatology: consensus statement and recommendations for enhanced recovery after cesarean. Anesth Analg. 2021;132(5):1362–77. doi: 10.1213/ANE.0000000000005257.
Weigl W, Bierylo A, Wielgus M, Krzemien-Wiczynska S, Kolacz M, Dabrowski MJ. Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section. 2017;96(48):e8892. doi: 10.1097/MD.0000000000008892.
Ikhwandi A, Apsari RKF, Rahardjo S. Perbandingan anestesi spinal bupivakain low dose dan conventional dose dalam mencapai adekuasi blok sensorik untuk prosedur seksio sesarea: penelitian noninferioritas acak tersamar tunggal. J Anestesi Obstet Indones. 2023;6(3):150–8. https://doi.org/10.47507/obstetri.v6i3.150.
Loho IR, Wisudarti CFR, Sudadi. Opioid intratekal pada enhanced recovery after surgery (eras). J Komplikasi Anestesi. 2023;11:62−75.
https://doi.org/10.22146/jka.v11i1.12640.
Barliana PC, Zulfariansyah A, Sitanggang RH. Perbandingan morfin dosis 0,05 mg dengan 0,1 mg sebagai adjuvan bupivakain 0,5% 10 mg intratekal terhadap intensitas nyeri dan durasi analgesia pascaseksio sesarea. J Anestesi Perioper. 2023;11(153):97–108. https://doi.org/10.15851/jap.v11n2.3395.
Grape S, El-Boghdadly K, Albrecht E. Management of adverse effects of intrathecal opioids in acute pain. Best Pract Res Clin Anaesthesiol. 2023;37(2):199–207. https://doi.org/10.1016/j.bpa.2023.02.002.
Isngadi I. Vasopressor pilihan untuk anestesi obstetri. J Anestesi Obstet Indones. 2024;7:54–62. https://doi.org/10.47507/obstetri.v7i1.154.
Chandraningrum AR, Supraptomo RTH, Laqif A. Perbandingan hipotensi antara anestesi general dan anestesi spinal pada seksio sesarea. Plex Med J. 2022;1(5):172–80. https://doi.org/10.20961/plexus.v1i5.278.
Quarshie A, Anno A, Djagbletey R, Sarpong P, Sottie D, Phillips BJ, et al. Comparison of crystalloid preloading and coloading for prevention of spinal-induced hypotension in cesarean delivery: a randomized controlled trial at a tertiary facility in Ghana. Open Access Maced J Med Sci. 2023;11(B):627−33. https://doi.org/10.3889/oamjms.2023.11657.
Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. Williams obstetrics. 26th ed. New York: McGraw-Hill Education; 2022.
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