Placenta accreta: anesthetic management and resuscitation strategies

ABSTRACT

Placenta accreta [PA] is the term used to describe the clinical condition of abnormal adherence of the entire or a part of the placenta to the uterine wall. Management of PA begins with the identification of high-risk patients with adequate screening. These patients need to be referred to the specialized centre, where a multidisciplinary team is formed and management plan is formulated. This involves patient's counselling with the possibility of hysterectomy, blood transfusion, ICU admission, postoperative ventilation and maternal and foetal risk of mortality. Arrangement of blood products, technique of anesthesia and the use of central venous line depends on the severity of the case. The presence of blood products in the operating room, pre-induction institution of A- line and two large bore cannulas and the use of rapid infusion set are recommended. In cases of massive haemorrhage in patients with PA, it is advisable to limit the use of crystalloids and colloids, and institute the damage control resuscitation by transfusing one unit of RBC along with one unit each of FFP and platelets