Anaesthetic Practices and Maternal Outcome in Rising Placenta Accreta Spectrum in Tertiary Care Hospital
Objective: This study was carried out to determine whether the rate of abnormal placentation is increasing in concurrence with the cesarean section and to assess risk factors and outcomes with multidisciplinary team interventions and anesthetic practices.
Study design: Prospective cohort study.
Material & Methods: A study was conducted in the department of anaesthesia from January 2014 to December 2017. All candidates under the spectrum of placenta accreta were observed for maternal age, parity, mode of anesthesia, blood loss, and outcome.
Results: Out of 109 patients, the preoperative diagnosis of PAS was made up of 100 (91.74%) and intraoperative diagnosis of 9 (08. 26%) patients. According to the mode of anesthesia, 100 (91.74%) patients received GA, and 09 (08.26%) patients received spinal anesthesia. In 06 (05.49%) patients, spinal was converted to GA. Perioperative CPR was done in 05 (04.58%) cases. Out of 109 cases, 83 survived uneventfully, and 21 developed complications. 05 patients expired in the following days. (01 immediately postoperative period, 02 in 1st 24 hours and 02 in 1st 48 hours.
Conclusion The rate of placenta accreta increased in conjunction with cesarean deliveries; the most important risk factors were previous cesarean delivery, placenta previa, and advanced maternal age and outcomes improved in a multidisciplinary team intervention.
2. Ismail S. Placenta accreta: anesthetic management and resuscitation strategies. Anaesthesia, Pain & Intensive Care. 2019 Jan 28:371-6.
3. Khokhar RS, Baaj J, Khan MU, Dammas FA, Rashid N. Placenta accreta and anesthesia: A multidisciplinary approach. Saudi journal of anaesthesia. 2016 Jul;10(3):332. doi: 10.4103/1658-354X.174913
4. Khong TY. The pathology of placenta accreta, a worldwide epidemic. Journal of clinical pathology. 2008 Dec 1;61(12):1243-6. http://dx.doi.org/10.1136/jcp.2008.055202
5. Rai V, Shariffuddin II, Chan YK, Muniandy RK, Wong KK, Singh S. Peri-operative management of hysterostomy in a parturient with complete heart block, placenta accreta and intrauterine death. BMC anesthesiology. 2014 Dec 1;14(1):49.
6. Kassem GA, Alzahrani AK. Maternal and neonatal outcomes of placenta previa and placenta accreta: three years of experience with a two-consultant approach. International journal of women's health. 2013;5:803. doi: 10.2147/IJWH.S53865
7. Russo M, Krenz EI, Hart SR, Kirsch D. Multidisciplinary approach to the management of placenta accreta. The Ochsner Journal 2011;11:84–88.
8. Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG: An International Journal of Obstetrics & Gynaecology. 2009 Apr;116(5):648-54. https://doi.org/10.1111/j.1471-0528.2008.02037.x
9. Wise A, Clark V. Strategies to manage major obstetric haemorrhage. Current Opinion in Anesthesiology. 2008 Jun 1;21(3):281-7. doi: 10.1097/ACO.0b013e3282f8e257
10. Weiniger CF, Elram T, Ginosar Y, Mankuta D, Weissman C, Ezra Y. Anaesthetic management of placenta accreta: use of a pre‐operative high and low suspicion classification. Anaesthesia. 2005 Nov;60(11):1079-84. https://doi.org/10.1111/j.1365-2044.2005.04369.x
Copyright (c) 2020 Sumbal Rana, Ali Arslan Munir, Qudsia Anjum Quraishi, Amim Muhammad Akhtar, Erum Pervaiz, Humna Syed
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.