Anesthetic Management of Patients with Placenta Accreta – 5 Years’ Experience

Introduction: The incidence of placenta accreta (PA) is 1/1667 to 1/70,000 pregnancies. Maternal mortality of 2-6% and hysterectomy rate of up to 30% were reported. Morbidity and mortality results mainly from massive bleeding and transfusion.

Aims: The aim of the present study was to retrospectively analyze data on patients with PA undergoing cesarean section (CS) in our institution, a referral center for patients with PA.

Methods: Data on patients undergoing CS for PA during the years 2012-2016 were analyzed.

Results: 175 patients undergoing CS for PA were included (1/285 deliveries). From these patients, 94 had significant intra-operative hemorrhage requiring blood transfusion (2 first degree; 33-second degree; and 51-third degree PA according to US evaluation. For eight patients, the grade was not recorded. The age of these 94 patients was 35±4.5 years (mean±SD), in 76 (80.8%) PA was associated with placenta previa, and CS was urgent in 26 (27.6%). CS was performed under general anesthesia in 90 (95.7%) and neuroaxial anesthesia in four (4.2%). Besides basic anesthesia monitoring, invasive arterial monitoring was used in 71 (75%). Estimated blood loss was 2,325±1,040 ml and mean transfusion was 3.9±2.7 PC units, 3.2±2.9 FFP units, and 8.4±6.5 cryoprecipitate units. Hysterectomy was performed in 21 (22.3%) and there was no mortality. On PACU admission, patients ‘body temperature was 36.6±0.5⁰C, SpO2 98.5±1.84%.

Conclusion: Despite significant blood loss and significant rate of hysterectomy delivery for patients with PA can be managed with no mortality and with low morbidity.