Management of placenta accreta: a survey of Maternal-Fetal Medicine practitioners

Abstract

Survey respondents employ diverse approaches in the management of patients with placenta accreta. Further study may lead to consensus strategies to improve outcome in this high-risk obstetric condition.

Israeli survey of anesthesia practice related to placenta previa and accreta

“…17 Reasons for conversion to general anesthesia were major hemorrhage and inadequate anesthesia. 12,14 In our survey, none of the representatives utilize this anesthesia technique. 24 Our survey of clinical practice among a range of institutions around Israel found that regardless of experience with PA cases, general anesthesia is preferred.…”

“…20 Anesthetic technique was analyzed according to the suspected abnormal placentation subtype: PP without suspected accreta, low suspicion for PA, and high suspicion for PA. 12 High suspicion PA comprised cases where the antenatal investigations showed PA, and low suspicion was defined as cases where the antenatal diagnosis of PA was uncertain. 20 Anesthetic technique was analyzed according to the suspected abnormal placentation subtype: PP without suspected accreta, low suspicion for PA, and high suspicion for PA. 12 High suspicion PA comprised cases where the antenatal investigations showed PA, and low suspicion was defined as cases where the antenatal diagnosis of PA was uncertain.…”

“…8 Prior to delivery, preparation for major hemorrhage is required which includes: placement of adequate intravenous access prior to anticipated hemorrhage, availability of a blood bank with access and availability to blood products, massive transfusion capabilities, and guidance for ongoing hemorrhage. 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). 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).…”

High‐intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta

“…American researchers have reported that the incidence of PA has increased from 0.08% to 0.3% between 1985 and 2005, 3 and Chinese researchers reported that the incidence of PA has increased ten-fold over the past 30 years, 4 an important obstetric problem in medical practice. Although there is more research on treatments for PA diagnosed before delivery to reduce maternal morbidity and mortality, [5][6][7] in many cases, PA can only be diagnosed after delivery with the placenta or placental tissue that failed to separate from the uterine wall. To avoid the massive haemorrhage caused by the forcible manual blunt dissection when obtaining an empty uterine cavity, a part of or even the whole placenta was left in situ during delivery.…”

Optimal strategies for conservative management of placenta accreta: a review of the literature

“…Although the optimal timing of delivery remains controversial, most women without any bleeding underwent planned delivery at 36 weeks gestation. 19,20) The Royal College of Obstetricians and Gynecologists (RCOG) states that a planned delivery at around 36-37 weeks of gestation (with corticosteroid cover) is a reasonable compromise for high-risk cases for having placenta accreta.…”