[Anesthetic management for cesarean section in two parturients with quintuplet gestation]

Two parturients with quintuplet pregnancy underwent urgent or elective cesarean section under general anesthesia at 30 and 29 week gestational ages respectively. Since multiple gestation pregnancy requires enough medical staffs and instruments for preterm newborn resuscitation, emergency cesarean delivery was avoided. For cesarean delivery, the operation was started immediately after crash induction and intubation, and less than 1% isoflurane balanced with 60% nitrous oxide was used before birth in attempt to maintain uterine relaxation and sufficient utero-placental perfusion. After the delivery, aggressive maneuvers with PGE1 infusion, intravenous ergometrine and oxytocin, and interruption of volatile anesthetic inhalation (replaced by buprenorphine) were employed for decreasing the blood loss. The anesthesia and postoperative course of two patients and their babies were uneventful. Thus, anesthetic considerations may include; 1) high risk pregnancy related with huge pregnant uterus, 2) preterm labor, 3) preparation of sufficient man-power and instruments, 4) to avoid uterine contraction before delivery for fetal oxygenation, and 5) the puerperal promotion of uterine contraction to decrease blood loss.