Placenta Accreta Spectrum Part I: anesthesia considerations based on an extended review of the literature

Abstract

“Placenta accreta spectrum” (PAS) describes abnormal placental adherence to the uterine wall without spontaneous separation at delivery. Though relatively rare, PAS presents a particular challenge to anesthesiologists, as it is associated with massive peripartum hemorrhage and high maternal morbidity and mortality. Standardized evidence-based PAS management strategies are currently evolving and emphasize: “PAS centers of excellence”, multidisciplinary teams, novel diagnostics/pharmaceuticals (especially regarding hemostasis, hemostatic agents, point-of-care diagnostics), and novel operative/interventional approaches (expectant management, balloon occlusion, embolization). Though available data are heterogeneous, these developments affect anesthetic management and must be considered in planed anesthetic approaches. This two-part review provides a critical overview of the current evidence and offers structured evidence-based recommendations to help anesthesiologists improve outcomes for women with PAS. This first part discusses PAS management in centers of excellence, multidisciplinary care team, anesthetic approach and monitoring, surgical approaches, patient safety checklists, temperature management, interventional radiology, postoperative care and pain therapy. The diagnosis and treatment of hemostatic disturbances and preoperative prepartum anemia, blood loss, transfusion management and postpartum venous thromboembolism will be addressed in the second part of this series.

Foley Catheter as a Tourniquet for Hemorrhage Prevention during Peripartum Hysterectomy in Patients with Placenta Accreta Spectrum (PAS)—A Hospital-Based Study

“…To date, no other publication on this topic matches the scale of our study, making it the largest English-language publication on the subject. We identified only four English-language publications, and together, they encompassed 23 patients who underwent perinatal hysterectomies due to PAS where a Foley catheter was used as a tourniquet [ 9 , 10 , 11 , 12 ]. The recurring exploration of tourniquets in these studies emphasizes the perceived potential of this technique in controlling hemorrhage during cesarean sections.…”

“…Traditional hemostatic measures, such as uterine compression sutures and arterial embolization, are promising but can be technically challenging or bring potential complications. Other methods, though documented, might lack reproducibility, especially in complex anatomical situations, may not be as effective, or could necessitate additional resources, elevating costs [ 11 , 12 , 13 ]. A more straightforward, cost-effective, and accessible technique is needed, even for less experienced clinicians.…”

The anesthetic approach to a patient with placenta accreta spectrum

“…There is even an associated risk for the development of postpartum depression with the use of general anesthesia for delivery [27]. Additional advantages of regional anesthesia include participation in the birth experience, parent-baby bonding, superior analgesia via intrathecal morphine or the use of epidural analgesia in the postoperative period with patient control epidural anesthesia (PCEA) [28,29 ]. Despite all of the advantages of regional anesthesia, there may also be cases that result in less favorable outcomes.…”

Postpartum Kanama

“…Bu ekip 7 gün 24 saat acil durumlar açısından ulaşılabilir olmalıdır. Ayrıca kan ve kan ürünleri temini yapılabilecek, erişkin ve neonatal yoğun bakım ihtiyacı karşılanabilecek, ilgili diğer bölümlerin aktif olarak hizmet verdiği merkezlerde hastaların yönetimi oluşabilecek morbidite ve mortalitede önemli oranda azalma sağlayacaktır (24).…”