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

Riveros-Pérez, Efraín; Wood, Cristina

doi:10.1002/ijgo.12366

Cited by 17 publications

(8 citation statements)

References 33 publications

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“…In our study, conversion to GA was performed in 21 (30%) cases, which is in accordance with the findings of a retrospective study by Lilker et al, where 29% of the patients with PAS underwent conversion to GA due to excessive bleeding [17]. Riveros-Peres et al suggested that, after the umbilical cord has been clamped, conversion of CSE to GA should be used as a routine anesthetic practice, especially when a protocol of massive hemorrhage is being employed [18]. The application of a neuraxialonly technique can avert certain complications of GA, provide better pain control, and minimize the need for transfusion [19].…”

Section: Discussionsupporting

confidence: 90%

Peripartum Ηysterectomy: A Four-Year Obstetric and Anesthetic Experience in a Tertiary Referral Hospital in Greece

Sindos¹,

Kalmatis²,

Samartzis³

et al. 2022

Cureus

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BackgroundAlthough peripartum hysterectomy (PH) is a life-saving procedure in cases of abnormal placentation and postpartum hemorrhage, it can be associated with major obstetric and anesthetic complications. This retrospective study aimed to evaluate the incidence, etiology, perioperative anesthetic and obstetric management, complications, and fetal outcomes in women undergoing PH in a single tertiary referral hospital in Greece. MethodologyThis was a retrospective analysis of medical records of women who underwent emergency or elective PH in our hospital between January 2015 and December 2018. ResultsDuring the study period, 69 women who underwent a PH were identified. The incidence rate of elective and emergency PH was 4 and 1.2 per 1,000 deliveries, respectively. The main indication for PH was abnormal placentation (81.2%), followed by uterine atony (13%). Conversion to general anesthesia (GA) was performed in 21 (30.4%) cases. ConclusionsThis study showed a high prevalence of PH in our hospital compared to high-income countries. A neuraxialonly technique may be a safe alternative in individual cases of abnormal placentation. Conversion to GA can be reserved for complex surgical cases when massive hemorrhage is anticipated and, if possible, after the neonate has been delivered.

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Section: Discussionsupporting

confidence: 90%

Peripartum Ηysterectomy: A Four-Year Obstetric and Anesthetic Experience in a Tertiary Referral Hospital in Greece

Sindos¹,

Kalmatis²,

Samartzis³

et al. 2022

Cureus

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“…[4][5][6][7] On the contrary, it is recommended that PAS patients be managed in tertiary care centers, underscoring the importance of resource availability and coordinated multispecialty care. 8 Surgical management of PAS entails multiple interventions aimed at limiting bleeding. The use of prophylactic hypogastric balloons is controversial, as it does not account for all the proximal uterine blood supply; and some authors have shown their inefficacy in cases of placenta percreta.…”

Section: Discussionmentioning

confidence: 99%

Supra-massive transfusion and interdisciplinary approach to cesarean hysterectomy due to complex placenta percreta: Case report

Riveros-Pérez

Sánchez

Odo

et al. 2021

SAGE Open Medical Case Reports

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Placenta accreta spectrum encompasses a group of conditions of abnormal placental infiltration of the uterine wall and surrounding tissues. It is associated with significant blood loss, perioperative morbidity, and risk of death. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease. We describe the successful management of a patient with placenta percreta who required supra-massive transfusion of blood products and interventions by different specialized teams in a tertiary care center.

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“…Some centers described a decreased use of GA over time, [7][8][9] while others reported increased use. [10][11][12] These data suggest that there is no clear consensus on the preferred choice of primary anesthetic. In cases in which NA is the preferred primary anesthetic, there was substantial variability in rates of sustained use of NA for the entire case (5-72%) and intraoperative conversion from NA to GA (7-70%).…”

Section: General Versus Neuraxial Anesthesiamentioning

confidence: 99%

Anesthesia Considerations for Placenta Accreta Spectrum

et al. 2023

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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

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

Abstract: Placenta previa and accreta coexist in many patients, leading to substantial bleeding related to the degree of myometrial invasion. An interdisciplinary team approach plus the use of combined spinal-epidural anesthesia, transitioning to general anesthesia, were advisable and safe.

Cited by 17 publications

References 33 publications

Peripartum Ηysterectomy: A Four-Year Obstetric and Anesthetic Experience in a Tertiary Referral Hospital in Greece

Peripartum Ηysterectomy: A Four-Year Obstetric and Anesthetic Experience in a Tertiary Referral Hospital in Greece

Supra-massive transfusion and interdisciplinary approach to cesarean hysterectomy due to complex placenta percreta: Case report

Anesthesia Considerations for Placenta Accreta Spectrum

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