Thoracic fluid content (TFC) is one of the many variables measured by the ICON electrical cardiometry (EC) device (Osypka Medical). The ICON device is often called "thoracic electrical bio-impedance" that based on measuring the changes in total resistance of the thorax to electric current and is considered a numerical measure of total (intravascular and extravascular) thoracic fluid. Although TFC is a measure of both extra and intra-vascular thoracic fluid, it provides an estimate of the increase in intrathoracic fluids such as to facilitate the risk of pulmonary edema.

Although many studies were done on the ability of TFC to detect pulmonary edema in preeclampsia, ARDS, heart failure, weaning from mechanical ventilation and during fluid management in prolonged surgery , yet, there is no study before was done on the use of TFC as a guide for fluid therapy during hypervolemic hemodilution in major obstetric surgery in patients with placenta accreta as one of the most common etiologies of life-threatening obstetric hemorrhage and the most common cause of peripartum hysterectomy

Aim of the work:

To use TFC as a guide for 6% HES infusion of hypervolemic hemodilution in patients with placenta accreta to avoid fluid overload.

Objectives:

• To calculate LUS score at the end of infusion.
• To evaluate TFC in k ohm-1.
• To assess oxygen saturation, PO2 and P/F ratio in ABG.
• To calculate the total infused volume in milliliters.

Inclusion Criteria:

• female
• 18-45 years old
• ASA I-II

Exclusion Criteria:

• younger than 18 years,
• ASA > or = III
• patients with respiratory, cardiac disease, cardiac arrhythmias,
• body mass index above 40 kg/m2
• renal insufficiency,
• sepsis,
• hypovolemia denoted by PPV > 13 detected after start of mechanical ventilation,
• preoperative baseline LUS score 10 or more,
• TFC > or = 26 k ohm-1,
• patients with neck or chest lesions that impair the application of cardiometry electrodes

Cesarean section patients

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