Skip to main content

Placenta Accreta Facts

Placenta accreta, an abnormally deep attachment of the placenta into the endometrium and myometrium (the middle layer of the uterine wall), complicates 3% of primary, 11% of secondary, 40% of tertiary, 61% of quaternary, and 67% of higher-order cesarean sections for placenta previa.6

The most common risk factor for abnormal placentation is previous cesarean section, but any invasive procedure that might affect the endometrium (including curettage, hysteroscopic surgery, myomectomy, and endometrial ablation) can increase the risk.

Differences in oxygen tension in abnormal placental beds have been invoked as a cause of abnormal placental invasion. It has been reported that preferential implantation of embryos into a relatively avascular scar tissue occurs because of decreased oxygen tension.9

Although the optimal timing for delivery is uncertain, early delivery is often recommended to minimize additional risks that are associated with emergent surgery.

Transcatheter arterial embolization for the control of obstetric hemorrhage has been shown to reduce blood loss and avoid hysterectomy in some cases.

Adequate blood products should be immediately available for transfusion with a rapid infuser. Evidence is now in favor of cell salvage in obstetrics, although this finding remains controversial.18 Recent evidence indicates that preoperative placement

Preoperative placement of ureteral stents is also associated with improved clinical outcome because clear identification of the ureters allows rapid completion of the hysterectomy.

 A vertical midline incision may be considered to achieve optimal visualization.

Many planned cesarean sections for placenta accreta are done with general anesthesia because of concerns for hemodynamic instability and the potential requirement for massive transfusion. However, in a classic study of cesarean hysterectomy at five institutions from the 1980s, 32% of planned cesarean hysterectomies were performed under regional anesthesia. There was no difference in intraoperative blood loss or hypotension, and no one required induction of general anesthesia.

If regional anesthesia is chosen, it is important to counsel the patient and her family about the possibility of conversion to general anesthesia in the setting of massive hemorrhage

Case series heavily populated by placenta accreta often document transfusion requirements of four to six units of pRBCs.

Anesthesiology:
October 2011 - Volume 115 - Issue 4 - p 852–857
Labels:

Comments

Post a Comment

Popular posts from this blog

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is  caffeine  prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg,  dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...
1 comment
Read more

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more