Anesthetic considerations for placenta accreta

Retrospective analysis of obstetric and anesthetic management of patients with placenta accreta spectrum disorders

“…Use of epidural and CSE anesthesia is advisable for patients with PAS disorders. Lilker et al . retrospectively studied 23 patients over 8 years and found that 29% of patients with planned neuraxial anesthesia underwent conversion to general anesthesia owing to excessive bleeding.…”

Israeli survey of anesthesia practice related to placenta previa and accreta

“…17,23 There are limited data describing mode of anesthesia for patients with suspected PA. 17 In our survey, representatives reported a preference for neuraxial techniques for PP management; however, the rate among representatives is lower than a previous report of Cesarean deliveries in a Taiwanese cohort where general anesthesia was performed for < 3% of the PP cases without hemorrhage. 17 Reasons for conversion to general anesthesia were major hemorrhage and inadequate anesthesia.…”

“…10,11 Compared to patients with PP, PA patients may require input from multiple disciplines, including obstetrics, anesthesiology, general surgery and interventional radiology, 12 and delivery at an earlier gestational age as recommended by the American College of Obstetricians and Gynecologists (34 weeks' gestational age). Although modes of anesthesia for PP and PA have been reported in a number of retrospective studies from single obstetric centers, [14][15][16][17][18] widespread anesthetic practices have not been previously described. For example, the decision to perform neuraxial or general anesthesia may depend upon the perceived risk of severe hemorrhage.…”

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

“…Recently, greater experience has permitted more frequent use of epidural with or without spinal. When managed appropriately and in an elective situation, most patients can tolerate both prolonged and extensive surgery with significant associated blood loss using these techniques …”