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Anesthetic Management of Women with Invasive Placentation: A Review of 55 Cases
Abstract Number: F 14
Abstract Type: Original Research
Invasive placentation is one of the most important causes of postpartum hemorrhage and cesarean hysterectomies. The incidence of placenta accreta continues to rise with the increasing rate of cesarean deliveries (CD) . In our institution, women benefit from a multidisciplinary team (MDT) care model that was implemented in 2008. The purpose of this study is to review the obstetric and anesthetic management of women with invasive placentation since 2000.
After REB approval, we conducted a retrospective review of all cases diagnosed with invasive placentation (accreta, increta and percreta) from 2000 to 2012. Patient demographic data, diagnostic imaging reports, surgical, interventional radiology and anesthesia procedures, blood loss and use of resuscitation products, complications and patient disposition including length of hospital stay were recorded. The data was analyzed based on the type of anesthesia (general or regional) for CD. P<0.05 was considered statistically significant.
Fifty-five cases were identified from hospital health records according to ICD-9/10-CA coding for placenta accreta. The most relevant findings are presented in table 1. The results reveal a trend towards less blood loss and a statistically significant (p=0.001) reduction in the need for blood transfusion in women who received regional anesthesia. The length of postoperative hospital stay was significantly less (p=0.022) in patients managed after the implementation of the MDT. We observed a significant change in the choice of surgical management of these cases from conservative uterine preservation to planned cesarean hysterectomy after 2008 (p =0.0001).
Our review suggests that epidural anesthesia is as safe and effective as general anesthesia in the management of these patients; furthermore it is associated with less need for intraoperative blood transfusion. It also suggests that a structured MDT approach can reduce length of hospital stay. The evolving change from a conservative approach to a planned pro-active cesarean hysterectomy seems to have improved patient outcome.
1. Anesthesiology 2011;115:852-7