The anesthetic approach to a patient with placenta accreta spectrum.
Journal
Current opinion in anaesthesiology
ISSN: 1473-6500
Titre abrégé: Curr Opin Anaesthesiol
Pays: United States
ID NLM: 8813436
Informations de publication
Date de publication:
01 Jun 2023
01 Jun 2023
Historique:
medline:
1
5
2023
pubmed:
7
2
2023
entrez:
6
2
2023
Statut:
ppublish
Résumé
Placenta accreta poses significant risk of morbidity and mortality to a laboring patient. Here we review available treatment options, highlight trends in bleeding prevention and diagnosis that have been shown to improve patient outcome, and provide best practice suggestions. We also discuss the decision-making process for choice of anesthesia, as it is not based on a gold-standard paradigm. The use of resuscitative endovascular balloon occlusion of the aorta has been gaining popularity around the world. It has been shown to cause an equivocal reduction in perioperative bleeding in placenta accreta spectrum (PAS), reduce the rate of hysterectomies, and is a safe and relatively easy technique. There are other invasive radiology techniques that have also proven to be beneficial in bleeding prevention: balloon occlusion of hypogastric arteries intraoperatively, internal iliac artery embolization, and intraoperative ligation of the hypogastric or uterine arteries. Optimal management of PAS begins with early and definitive diagnosis. A multidisciplinary approach along with preparation of special equipment and the use of a check-list maximize the chance for success. Anesthesia could be done with all types of regional or under general, considering case-by-case factors but most importantly choosing according to the institution's best facility and skill.
Identifiants
pubmed: 36745077
doi: 10.1097/ACO.0000000000001242
pii: 00001503-202306000-00004
doi:
Substances chimiques
Anesthetics
0
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
263-268Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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