Abstract
Objective: To assess the management and maternal outcomes of placenta accreta spectrum (PAS) disorders. Methods: A retrospective chart review was conducted of patients diagnosed with PAS disorders (placenta creta, increta, or percreta) who were treated at a US tertiary care center between February 1, 2011, and January 31, 2016. Obstetric management, anesthetic management, and maternal outcomes were analyzed. Results: A total of 43 cases were identified; placenta previa was diagnosed among 33 (77%). Median age was 33 years (range 23–42). Median blood loss was 1500 mL (interquartile range 1000–2500); blood loss was greatest among the 10 patients with placenta percreta (3250 mL, interquartile range 2200–6000). Transfusion of blood products was necessary among 14 (33%) patients, with no difference in frequency according to the degree of placental invasion (P=0.107). Surgical complications occurred among 10 (23%) patients. Overall, 30 (70%) patients received combined spinal–epidural plus general anesthesia, 4 (9%) received only general anesthesia, and 9 (21%) underwent surgery with combined spinal–epidural anesthesia. One patient experienced difficult airway and another experienced accidental dural puncture. Conclusion: 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 370-374 |
| Number of pages | 5 |
| Journal | International Journal of Gynecology and Obstetrics |
| Volume | 140 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2018 |
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Keywords
- High-risk obstetrics
- Intrapartum hemorrhage
- Obstetric anesthesia
- Placenta accreta spectrum disorders
- Retrospective study
- Uterine bleeding
ASJC Scopus subject areas
- Obstetrics and Gynecology
Cite this
Retrospective analysis of obstetric and anesthetic management of patients with placenta accreta spectrum disorders. / Riveros Perez, Efrain; Wood, Cristina.
In: International Journal of Gynecology and Obstetrics, Vol. 140, No. 3, 01.03.2018, p. 370-374.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Retrospective analysis of obstetric and anesthetic management of patients with placenta accreta spectrum disorders
AU - Riveros Perez, Efrain
AU - Wood, Cristina
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Objective: To assess the management and maternal outcomes of placenta accreta spectrum (PAS) disorders. Methods: A retrospective chart review was conducted of patients diagnosed with PAS disorders (placenta creta, increta, or percreta) who were treated at a US tertiary care center between February 1, 2011, and January 31, 2016. Obstetric management, anesthetic management, and maternal outcomes were analyzed. Results: A total of 43 cases were identified; placenta previa was diagnosed among 33 (77%). Median age was 33 years (range 23–42). Median blood loss was 1500 mL (interquartile range 1000–2500); blood loss was greatest among the 10 patients with placenta percreta (3250 mL, interquartile range 2200–6000). Transfusion of blood products was necessary among 14 (33%) patients, with no difference in frequency according to the degree of placental invasion (P=0.107). Surgical complications occurred among 10 (23%) patients. Overall, 30 (70%) patients received combined spinal–epidural plus general anesthesia, 4 (9%) received only general anesthesia, and 9 (21%) underwent surgery with combined spinal–epidural anesthesia. One patient experienced difficult airway and another experienced accidental dural puncture. Conclusion: 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.
AB - Objective: To assess the management and maternal outcomes of placenta accreta spectrum (PAS) disorders. Methods: A retrospective chart review was conducted of patients diagnosed with PAS disorders (placenta creta, increta, or percreta) who were treated at a US tertiary care center between February 1, 2011, and January 31, 2016. Obstetric management, anesthetic management, and maternal outcomes were analyzed. Results: A total of 43 cases were identified; placenta previa was diagnosed among 33 (77%). Median age was 33 years (range 23–42). Median blood loss was 1500 mL (interquartile range 1000–2500); blood loss was greatest among the 10 patients with placenta percreta (3250 mL, interquartile range 2200–6000). Transfusion of blood products was necessary among 14 (33%) patients, with no difference in frequency according to the degree of placental invasion (P=0.107). Surgical complications occurred among 10 (23%) patients. Overall, 30 (70%) patients received combined spinal–epidural plus general anesthesia, 4 (9%) received only general anesthesia, and 9 (21%) underwent surgery with combined spinal–epidural anesthesia. One patient experienced difficult airway and another experienced accidental dural puncture. Conclusion: 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.
KW - High-risk obstetrics
KW - Intrapartum hemorrhage
KW - Obstetric anesthesia
KW - Placenta accreta spectrum disorders
KW - Retrospective study
KW - Uterine bleeding
UR - http://www.scopus.com/inward/record.url?scp=85034752983&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85034752983&partnerID=8YFLogxK
U2 - 10.1002/ijgo.12366
DO - 10.1002/ijgo.12366
M3 - Article
C2 - 29080306
AN - SCOPUS:85034752983
VL - 140
SP - 370
EP - 374
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
SN - 0020-7292
IS - 3
ER -