Ethical And Medicolegal Considerations For Termination Of Pregnancy In Cases Of Placenta Accreta With Massive Bleeding At 18-19 Weeks Of Gestation: A Case Report
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 10, Pages 2172-2177
AbstractPlacenta accreta is one of the complications of pregnancy in the form of adhesion of part or total of the placenta to the myometrium which can pose a risk of placenta praevia and massive bleeding. We report a case of a patient aged 41 years during her fifth pregnancy with gestational age 18-19 weeks who experienced placenta praevia totalis with suspected placenta accreta having complaints of recurrent active bleeding from the birth canal. The ethical dilemma that occurs concerns how the action should be taken and when the action is taken? The ethical consideration used in this case is the minus malum principle, namely by considering which one carries the least risk among the two, namely termination of pregnancy or continuing the pregnancy with the risk of threatening the mother's life due to bleeding. Medicolegal considerations used double effect and patient safety principles in obstetrics care. In this case it was decided to do pregnancy termination by total hysterectomy on the basis of maternal safety considerations.
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