Advances in anesthetic and obstetric management of patients with placenta accreta spectrum

Abstract

Purpose of reviewThe incidence of placenta accreta spectrum is increasing and it is a leading cause of peripartum hysterectomy and massive postpartum hemorrhage. The purpose of the present article is to provide a contemporary overview of placenta accreta spectrum pertinent to the obstetric anesthesiologist. Recent findingsRecent changes in the terminology used to report invasive placentation were proposed to clarify diagnostic criteria and guidelines for use in clinical practice. Reduced morbidity is associated with scheduled preterm delivery in a center of excellence using a multidisciplinary team approach. Neuraxial anesthesia as a primary technique is increasingly being used despite the known risk of major bleeding. The use of viscoelastic testing and endovascular interventions may aid hemostatic resuscitation and improve outcomes. SummaryAccurate diagnosis and early antenatal planning among team members are essential. Obstetric anesthesiologists should be prepared to manage a massive hemorrhage, transfusion, and associated coagulopathy. Increasingly, viscoelastic tests are being used to assess coagulation status and the ability to interpret these results is required to guide the transfusion regimen. Balloon occlusion of the abdominal aorta has been proposed as an intervention that could improve outcomes in women with placenta accreta spectrum, but high-quality safety and efficacy data are lacking.

A Retrospective Study on the Clinical Effect of Uterine Artery Embolization Combined with Cervical Double Balloon for Patients with Complete Placenta Previa Undergoing Pregnancy Termination in the Second Trimester

“…One of the main challenges in management of the second-trimester pregnancy termination for women with CPP is prenatal massive vaginal bleeding from placenta located in the cervical os with an unfavorable cervix. In some cases, total or subtotal hysterectomy [5,6] is needed to stop those life-threatening bleeding. Mifepristone combined with ethacridine lactate/misoprostol is common method used in the second-trimester pregnancy termination in China especially for those CPP patients [7] , and those methods of drugs are effective and safe [8,9] .…”