Anesthesia Considerations for Placenta Accreta Spectrum

Abstract

Anesthesiologists are critical members of the multidisciplinary team managing patients with suspected placenta accreta spectrum (PAS). Preoperatively, anesthesiologists provide predelivery consultation for patients with suspected PAS where anesthetic modality and invasive monitor placement is discussed. Additionally, anesthesiologists carefully assess patient and surgical risk factors to choose an anesthetic plan and to prepare for massive intraoperative hemorrhage. Postoperatively, the obstetric anesthesiologist hold unique skills to assist with postoperative pain management for cesarean hysterectomy. We review the unique aspects of peripartum care for patients with PAS who undergo cesarean hysterectomy and explain why these responsibilities are critical for achieving successful outcomes for patients with PAS. Key Points

Perioperative outcomes and causes of postpartum hemorrhage in patients undergoing cesarean delivery in Thailand: A comprehensive retrospective study

“…Although general anesthesia is linked to severe PPH (bleeding ≥ 1500 ml) in cesarean deliveries, our data indicated a markedly higher use of general anesthesia in cases of abnormal placentation than in those attributed to uterine atony or trauma-related causes [ 34 ]. Factors such as preexisting antepartum bleeding, which can lead to preoperative hypotension, and the expectation of significant hemorrhage from abnormal placentation could prompt anesthesiologists to lean toward general anesthesia for such patients [ 27 , 28 ].…”

“…In individuals diagnosed prenatally with placenta accreta spectrum, the choice of anesthesia for cesarean delivery depends on various factors, including the patient's comorbidities, the extent of placental invasion, and resource availability [26][27][28]. Regional anesthesia is typically the preferred technique for cesarean delivery; however, it often leads to maternal hypotension [29][30][31].…”

“…Early identification of hemorrhage requiring massive transfusion is crucial for optimizing patient outcomes. [4,[37][38][39] Collaborative consultations involving obstetricians, anesthesiologists, hematologists, transfusion medicine specialists, and neonatologists should be promptly initiated [11,[26][27][28][37][38][39][40].…”