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Anaesthetic management of placenta accreta – a nine year experience in a tertiary obstetric centre
Abstract Number: T-06
Abstract Type: Original Research
Placenta accreta is associated with significant maternal morbidity and mortality. Traditional management involved massive blood transfusion and performing a Caesarean hysterectomy, with implication on future fertility. Current management of placenta accreta focuses on a multidisciplinary approach, minimizing haemorrhage and facilitating uterine conservation. The aim of this retrospective study is to report the incidence, anaesthetic management and outcomes of parturients with placenta accreta at a tertiary obstetric hospital over a nine-year period.
After approval from the institutional review board, parturients diagnosed with placenta accreta in the period 1 Jan 2004 to 31 Dec 2012 were identified from hospital records using the relevant ICD codes and their case records reviewed retrospectively to extract the following details: demographic data, antenatal diagnosis of placenta accreta, choice of anaesthetic technique for Caesarean delivery, intraoperative blood loss, transfusion requirements, duration of surgery, Caesarean vs delayed hysterectomy and duration of ICU and hospital stay. Data was analysed using Microsoft Excel 2010 software. Subgroup comparison was made between parturients who were managed before and after introduction of a multidisciplinary management protocol.
Over the nine-year period, 78 patients were diagnosed with placenta accreta, giving an incidence of 1 in 1414 births. Data was eventually analysed from 72 patients, due to missing records. Majority of accreta were diagnosed intraoperatively. Twenty-four parturients underwent femoral artery catheter insertion preoperatively. GA was the predominant anaesthetic technique utilized. Mean blood loss was 3716 ml. Median red cell: plasma: platelet utilization was 10:6:4 units. All parturients required hysterectomy – 61 Caesarean vs 7 delayed hysterectomies. Mean length of stay in ICU and hospital were 1.6 days and 4.4 days respectively. After introducing protocolised multidisciplinary management, there is a trend towards improved antenatal diagnosis, increased radiological interventions (45.5% vs 24.6%) and reduction in blood loss (2120ml vs 4106ml).
Effective diagnosis and multidisciplinary involvement, including a detailed surgical plan and planned post operative care, are the key changes in our institution’s management protocol, with a trend towards improved outcomes.