Obstetric Anesthesia

Complications in Obstetrics and Obstetric Anesthesia

Anesthetic considerations for placenta accreta

Lilker SJ, Meyer RA, Downey KN, et al (Mount Sinai Hosp, Toronto, Ontario, Canada) Int J Obstet Anesth 20:288-292, 2011^§

Abstract

Background

When diagnosed antenatally placenta accreta has often been managed by cesarean hysterectomy, but recently techniques involving uterine preservation have been developed. Uterine artery embolization has become an adjuvant treatment, although the potential for obstetric hemorrhage still exists. A multidisciplinary approach has permitted the development of anesthetic strategies for these patients.

Methods

A retrospective case note review of patients with placenta accreta between 2000 and 2008 at our institution was conducted. Anesthetic technique, estimated blood loss, requirement for blood products and disposition of patients postoperatively were recorded.

Results

A total of 23 cases were identified. In six, epidural anesthesia with progression to general anesthesia was planned. In 17 cases, neuraxial anesthesia was planned and in five of these (29%) excessive blood loss necessitated conversion to general anesthesia. Nine patients (39%) had intraoperative blood loss estimated at >2 L, and six required intraoperative blood transfusion. Eleven patients (48%) required hysterectomy, seven of which were performed on the day of delivery.

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