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Am J Perinatol 2023; 40(09): 980-987
DOI: 10.1055/s-0043-1761637
PAS Series Article
Review Article

Anesthesia Considerations for Placenta Accreta Spectrum

Christine M. Warrick
1   Department of Anesthesiology, School of Medicine, University of Utah Hospital, Salt Lake City, Utah
,
Caitlin D. Sutton
2   Department of Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Michaela M. Farber
3   Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
,
Philip E. Hess
4   Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Alexander Butwick
5   Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University Medical Center, Palo Alto, California
,
John C. Markley
6   Department of Anesthesia and Perioperative Care, University of California San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Abstract

Anesthesiologists are critical members of the multidisciplinary team managing patients with suspected placenta accreta spectrum (PAS). Preoperatively, anesthesiologists provide predelivery consultation for patients with suspected PAS where anesthetic modality and invasive monitor placement is discussed. Additionally, anesthesiologists carefully assess patient and surgical risk factors to choose an anesthetic plan and to prepare for massive intraoperative hemorrhage. Postoperatively, the obstetric anesthesiologist hold unique skills to assist with postoperative pain management for cesarean hysterectomy. We review the unique aspects of peripartum care for patients with PAS who undergo cesarean hysterectomy and explain why these responsibilities are critical for achieving successful outcomes for patients with PAS.

Key Points

  • Anesthesiologists are critical members of the multidisciplinary team planning for patients with suspected placenta accreta spectrum.

  • Intraoperative preparation for massive hemorrhage is a key component of anesthetic care for patients with PAS.

  • Obstetric anesthesiologists have a unique skill set to manage postpartum pain and postoperative disposition for patients with PAS who undergo cesarean hysterectomy.

Keywords

anesthesia - cesarean section - hysterectomy - placenta accreta - postpartum hemorrhage


Publication History

Article published online:
19 June 2023

© 2023. Thieme. All rights reserved.

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