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Israeli National Survey of Anesthesia Practice Related to Placenta Previa and Accreta
Abstract Number: S-12
Abstract Type: Original Research
Background: Anesthesia practices for placenta previa and accreta may impact hemorrhage management and other supportive strategies. (1) We conducted a national survey of anesthesia practice patterns for placenta previa (PP), low suspicion placenta accreta (PA) and high suspicion (or recognized) PA in Israel.
Methods: Following Institutional Board Waiver we contacted the directors of obstetric anesthesia in all Israeli hospitals that offer Labor and Delivery services and have an intensive care unit (N=23). Directors were contacted by email with follow-up telephone calls using a specifically constructed survey (after face validation by anesthesiology colleagues) that inquired about annual number of PP and PA cases, pre-operative, intra-operative and post-operative strategies and institutional resources. Our primary outcome was anesthesia mode for abnormal placentation. Univariate statistics were used for survey responses using counts and percentages.
Results: The survey was performed between Jan-May 2014 and had an 100% response rate. Over half the directors surveyed (12 (52.2%)) manage more than 5 PA cases annually. Massive transfusion protocols and TEG are used in 19 (82.6%) and 14 (60.9%) units respectively. A cell saver is available in 5 (21.7%) units but used routinely in only 2 (8.7%) units for PA cases. Ultrasound is used in all units to diagnose PA; MRI is used in only 9(39.1%) units. Neuraxial anesthesia is used in 17 (73.9%) units for PP, 7 (30.4%) for low suspicion PA and 1 (4.3%) for high suspicion PA. Elective cesarean delivery for high suspicion PA is scheduled at <36 weeks in 6 (26.1%) units, 36-38 weeks in 16 (69.6%) units, and >38 weeks in 1 (4.3%) unit. Multidisciplinary antenatal planning occurs in 18 (78.3%) units prior to cesarean delivery for high suspicion PA. Pre-operatively, blood products are brought into the operating room for PA cases in 21 (91.3%) units. The table summarizes peri-operative anesthesia management strategies for PP and PA.
Conclusions: We found wide variations in practice patterns, specifically with regard to anesthesia mode, multidisciplinary management, timing of delivery, transfusion and hemorrhage strategies. Although neuraxial anesthesia is the most popular anesthesia choice for placenta previa, general anesthesia was overwhelmingly the most widely used anesthesia technique for suspected placenta accreta in Israel.