Placenta accreta spectrum disorders - Peri-operative management: The role of the anaesthetist. (April 2021)

• Record Type: Journal Article
• Authors: Hawkins, Richard; Evans, Matthew; Hammond, Sarah; Hartopp, Richard; Evans, Emma
• Is Part Of: Best practice & research. Volume 72(2021)
• Page Start: 38
• Page End: 51
• Publication Date: 2021-04
• Subjects: Placenta diseases -- Placenta accreta spectrum disorders -- Anaesthesia -- Perioperative care -- Postpartum haemorrhage; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2020.08.003
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract: The incidence of placenta accreta spectrum (PAS) is increasing and will become more commonly encountered by obstetric anaesthetists in the elective and emergency settings. Significant maternal and neonatal morbidity is associated with these disorders, and hence it is important for anaesthetists to have early involvement in perioperative planning. Major haemorrhage should be anticipated and requires robust perioperative preparation including Patient Blood Management (PBM) and use of intraoperative strategies for haemorrhage management wherever possible. Several institutions have demonstrated good outcomes with regional anaesthesia alone, but the choice of anaesthetic technique requires individualised planning considering patient, anaesthetic and surgical factors. Optimisation of postoperative analgesia needs additional consideration; it is key to good recovery, minimising the impact on quality of life and reducing the risk of persistent post-surgical pain. Further research is required to ascertain the optimal multi-modal analgesic regime including the role of peripheral nerve blockade. Highlights: Known cases of placenta accreta spectrum (PAS) disorders should be referred to a specialist centre. The perioperative management of PAS should be multi-disciplinary. There is ongoing debate regarding the ideal anaesthetic technique for PAS. The incidence of PAS is increasing, and all anaesthetists should be aware of the condition. Massive haemorrhage should be pre-empted, including routine use of tranexamic acid.