BACKGROUND Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality. CASE PRESENTATION This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient's death. CONCLUSION This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.

中文翻译：

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“您只能活两次”：胎盘Accreta Spectrum中的灾难性病例的多学科管理-病例报告。

背景技术胎盘穿孔与出血风险高有关，并可能与致命的血栓栓塞事件并发。为了降低发病率和死亡率，必须让多学科团队参与这些患者的治疗。病例介绍本文报道了一名22岁的患有胎盘穿孔的患者的病例，该患者被转介到我们的三级护理中心进行分娩。在成功进行剖宫产子宫切除术后数小时，患者出现了肺栓塞和心脏骤停。重症监护病房（ICU）进行的经胸超声心动图检查显示右心室有血栓。心脏复苏后，患者进行了紧急的开胸手术和肺动脉血栓切除术。从肺动脉中回收了许多凝块。退出体外循环后，术中经食道心脏超声检查使医疗团队能够在右心房和右心室中发现新的自由漂浮血栓，从而进行栓子切除术并防止患者死亡。结论该病例强调了多学科团队在治疗高危产科病例中的作用，这些病例可能并发大规模致命性血栓栓塞事件。术中经胸超声心动图的使用有助于发现新的血栓，并指导麻醉师进行术中监测。结论该病例强调了多学科团队在治疗高危产科病例中的作用，这些病例可能并发大规模致命性血栓栓塞事件。术中经胸超声心动图的使用有助于发现新的血栓，并指导麻醉师进行术中监测。结论该病例强调了多学科团队在治疗高危产科病例中的作用，这些病例可能并发大规模致命性血栓栓塞事件。术中经胸超声心动图的使用有助于发现新的血栓，并指导麻醉师进行术中监测。