A novel approach to reduce blood loss in patients with placenta accreta spectrum disorder

2019 ◽  
pp. 1-10 ◽  
Author(s):  
Ozhan M. Turan ◽  
Allison Shannon ◽  
Mehmet R. Asoglu ◽  
Katherine R. Goetzinger
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Spectrum Disorder ◽  
Reduce Blood Loss ◽  
Novel Approach ◽  
Placenta Accreta Spectrum

scholarly journals Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

2020 ◽  
Author(s):  
Anja Bluth ◽  
Axel Schindelhauer ◽  
Katharina Nitzsche ◽  
Pauline Wimberger ◽  
Cahit Birdir
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Placenta Accreta ◽  
Caesarean Section Rate ◽  
Management Strategies ◽  
Management Approach ◽  
Optimal Setting ◽  
Placenta Accreta Spectrum ◽  
Management Approaches

Abstract Purpose Placenta accreta spectrum (PAS) disorders can cause major intrapartum haemorrhage. The optimal management approach is not yet defined. We analysed available cases from a tertiary perinatal centre to compare the outcome of different individual management strategies. Methods A monocentric retrospective analysis was performed in patients with clinically confirmed diagnosis of PAS between 07/2012 and 12/2019. Electronic patient and ultrasound databases were examined for perinatal findings, peripartum morbidity including blood loss and management approaches such as (1) vaginal delivery and curettage, (2) caesarean section with placental removal versus left in situ and (3) planned, immediate or delayed hysterectomy. Results 46 cases were identified with an incidence of 2.49 per 1000 births. Median diagnosis of placenta accreta (56%), increta (39%) or percreta (4%) was made in 35 weeks of gestation. Prenatal detection rate was 33% for all cases and 78% for placenta increta. 33% showed an association with placenta praevia, 41% with previous caesarean section and 52% with previous curettage. Caesarean section rate was 65% and hysterectomy rate 39%. In 9% of the cases, the placenta primarily remained in situ. 54% of patients required blood transfusion. Blood loss did not differ between cases with versus without prenatal diagnosis (p = 0.327). In known cases, an attempt to remove the placenta did not show impact on blood loss (p = 0.417). Conclusion PAS should be managed in an optimal setting and with a well-coordinated team. Experience with different approaches should be proven in prospective multicentre studies to prepare recommendations for expected and unexpected need for management.

scholarly journals The Choice of Anesthesia During Organ-Saving Operations Concerning Patients With Placenta Accreta Spectrum Disorders

2020 ◽  
Vol 9 (2) ◽  
pp. 221-230
Author(s):  
E. N. Plakhotina ◽  
T. N. Belousova ◽  
I. A. Kulikov ◽  
R. V. Latyshev ◽  
K. M. Pavlyutina
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Placenta Accreta ◽  
Pain Syndrome ◽  
Tissue Perfusion ◽  
Optimal Method ◽  
Clear Trend ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Abstract Placenta accreta (PAS-disorders) is one of the most serious complications of pregnancy, associated with the risk of massive uterine bleeding, massive hemotransfusion and maternal mortality. Peripartum hysterectomy is a common treatment strategy for patients with placenta accreta. Currently, there is a clear trend of changing surgical tactics in favor of organ-saving operations, but there are no studies devoted to anesthesiological support of such operations.The aim of the study is to substantiate an effective and safe method of anaesthesia in organ-saving operations for placenta accreta spectrum disorders.Materia l and methods The study involved 80 patients with a diagnosis of placenta accreta spectrum disorders, confirmed intraoperatively, who underwent organ-saving operations. The patients were randomized depending on the method of anesthesia into 3 groups: general anesthesia, spinal anesthesia with planned conversion to general after fetal extraction and epidural anesthesia with planned conversion to general also after fetal extraction. The comparison of intraoperative hemodynamics, efficiency of tissue perfusion, efficiency of antinociceptive protection at the stages of surgery was performed. A comparative analysis of the volume of blood loss and blood transfusion, time of patients activation in the postoperative period, severity of pain on the first day after surgery, duration of hospital stay before discharge and comparison of the assessment of the newborn according to Apgar score at first and fifth minute after extraction.Conclusion The study shows that the optimal method of anesthesia in organ-saving operations for placenta accreta spectrum disorders is epidural anesthesia with its planned conversion to general anesthesia with an artificial lung ventilation after fetal extraction. Such an approach to anesthesia allows to maintain stable hemodynamic profile with minimal vasopressor support, sufficient heart performance, providing effective tissue perfusion and a high level of antinociceptive protection at the intraoperative stage and reduce the volume of intraoperative blood loss and hemotransfusion. In the current study there were no differences in neonatal outcomes and duration of hospitalization depending on the method of anesthesia. The advantage of epidural anesthesia with its conversion to general anesthesia was earlier activation after surgery and lower intensity of postoperative pain syndrome.

Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss

2020 ◽  
pp. 1-10
Author(s):  
Liviu Cojocaru ◽  
Allison Lankford ◽  
Jessica Galey ◽  
Shobana Bharadwaj ◽  
Bhavani S. Kodali ◽  
...  
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Operative Blood Loss ◽  
Placenta Accreta Spectrum

scholarly journals Impact of placenta previa with placenta accreta spectrum disorder on fetal growth

2019 ◽  
Vol 54 (5) ◽  
pp. 643-649 ◽  
Author(s):  
E. Jauniaux ◽  
I. Dimitrova ◽  
N. Kenyon ◽  
M. Mhallem ◽  
N. A. Kametas ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Spectrum Disorder ◽  
Placenta Accreta Spectrum

The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders

2020 ◽  
Vol 302 (5) ◽  
pp. 1143-1150
Author(s):  
Ahmed M. Hussein ◽  
Mohamed Momtaz ◽  
Ahmad Elsheikhah ◽  
Ahmed Abdelbar ◽  
Ahmed Kamel
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Operative Blood Loss ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders
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