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A Multidisciplinary Protocol for Antenatally Diagnosed Placenta Accreta: A Retrospective Case Series
Abstract Number: S-36
Abstract Type: Original Research
Introduction: The recent increased frequency of cesarean delivery has been accompanied by an increased incidence of placenta accreta, a potential cause of massive obstetrical hemorrhage. With advances in radiologic techniques, placenta accreta has become diagnosed earlier in pregnancy and more accurately. Cesarean hysterectomy is a common strategy for management of placenta accreta, and several interventional radiologic (IR) procedures have been utilized to reduce post-partum hemorrhage. Newer management approaches for addressing placenta accreta necessitate a multidisciplinary approach. The team at our institution consists of the obstetrical, gynecologic oncology, obstetric anesthesiology, neonatal intensive care, transfusion medicine, IR, labor and delivery nursing, and operating room management teams.
Objective: To evaluate the potential benefits and success of a multidisciplinary approach to managing antenatally diagnosed placenta accreta cases.
Methods: This is a retrospective review series of fifteen cases of antenatally diagnosed placenta accreta at our institution between 2011 and 2014 that underwent our placenta accreta protocol for cesarean delivery. Patient demographics, calculated blood loss, transfusion requirements, type of anesthetic technique and quality measures were assessed and evaluated. We utilized estimated blood loss as a reflection of the anesthesiologist’s assessment of estimated blood loss, and used the theoretical dilution theory and transfused red blood cell volume to calculate blood loss.
Results: We successfully managed 67.7% of antenatally diagnosed placenta accreta cases with regional anesthesia. The average calculated blood loss for cases performed with regional anesthesia was 1409mL and 6412mL for cases utilizing general anesthesia (p-value < 0.05). In addition, the difference between calculated blood loss and clinically estimated blood loss was 570mL (p-value 0.53).
Conclusions: The multidisciplinary team management approach to the cesarean delivery of patients with antenatally diagnosed placenta accreta can lead to fewer cases of general anesthesia and subsequently less blood loss. Clinically estimated blood loss does not significantly underestimate calculated blood loss.
Wu S, et al. Abnormal placentation: twenty-year analysis. Am J ObstetGynecol 2005;192:1458-61.
Russo M, et al. Multidisciplinary Approach to the Management of Placenta Accreta. The OchsnerJourna. 11:84-88,2011.