Placenta Accreta Spectrum Part II: hemostatic considerations based on an extended review of the literature.

Abstract

"Placenta Accreta Spectrum" (PAS) is a rare but serious pregnancy condition where the placenta abnormally adheres to the uterine wall and fails to spontaneously release after delivery. When it occurs, PAS is associated with high maternal morbidity and mortality - as PAS management can be particularly challenging. This two-part review summarizes current evidence in PAS management, identifies its most challenging aspects, and offers evidence-based recommendations to improve management strategies and PAS outcomes. The first part of this two-part review highlighted the general anesthetic approach, surgical and interventional management strategies, specialized "centers of excellence," and multidisciplinary PAS treatment teams. The high rates of PAS morbidity and mortality are often provoked by PAS-associated coagulopathies and peripartal hemorrhage (PPH). Anesthesiologists need to be prepared for massive blood loss, transfusion, and to manage potential coagulopathies. In this second part of this two-part review, we specifically reviewed the current literature pertaining to hemostatic changes, blood loss, transfusion management, and postpartum venous thromboembolism prophylaxis in PAS patients. Taken together, the two parts of this review provide a comprehensive survey of challenging aspects in PAS management for anesthesiologists.

• Authors: Rick Enste, Patrick Cricchio, Pierre-Yves Dewandre, Thorsten Braun, Christopher O Leonards, Phil Niggemann, Claudia Spies, Wolfgang Henrich, Lutz Kaufner
• Journal: Journal of perinatal medicine (J Perinat Med) Vol. 51 Issue 4 Pg. 455-467 (May 25 2023) ISSN: 1619-3997 [Electronic] Germany
• PMID: 36181735 (Publication Type: Journal Article, Review)
• Copyright: © 2022 the author(s), published by De Gruyter, Berlin/Boston.

Chemical References

• Hemostatics

Topics

• Pregnancy
• Female
• Humans
• Retrospective Studies
• Placenta Accreta (surgery)
• Cesarean Section
• Hemostatics (therapeutic use)
• Postpartum Hemorrhage (etiology, prevention & control)
• Hysterectomy
• Placenta
• Placenta Previa (surgery)