[Anesthetic management for cases of placenta accreta presented for cesarean section: a 7-year single-center experience]

Abstract

Background: Anesthetic management of cesarean section for placenta accreta is very challenging. The aim of our retrospective study was to review past placenta accreta cases in our hospital to suggest a strategy for anesthetic management for placenta accreta.

Methods: Placenta accreta cases were identified in our obstetric anesthesia data base. Their diagnosis, surgical procedure, amount of blood loss and anesthetic management were reviewed.

Results: Twenty-two cases of placenta accreta were identified. Of them 16 cases underwent cesarean hysterectomy. The amount of blood loss in the 22 cases ranged from 590 to 10500 ml. Neuraxial anesthesia alone was planned in 11 cases, 6 of which were converted to general anesthesia due to massive bleeding. In most of the cases, more than 2 large-bore intravenous lines and arterial line were placed prior to the beginning of surgery. All cases were well managed.

Conclusions: We suggest the minimum requirements for anesthetic management in patients with placenta accreta as follows: (1) discussion with obstetricians to formulate a cesarean section plan, (2) early evaluation to formulate an anesthetic plan and to obtain informed consent, (3) two experienced anesthesiologists, (4) general anesthesia, (5) 2 large-bore intravenous lines, (6) an arterial line and (7) 10 units of both fresh frozen plasma and crossmatched packed red blood cells.