Placenta Accreta Spectrum Part II: hemostatic considerations based on an extended review of the literature
Author:
Enste Rick1ORCID, Cricchio Patrick1, Dewandre Pierre-Yves2ORCID, Braun Thorsten3ORCID, Leonards Christopher O.1, Niggemann Phil1ORCID, Spies Claudia1ORCID, Henrich Wolfgang3, Kaufner Lutz1ORCID
Affiliation:
1. Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) , Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin , Germany 2. Department of Anesthesia and Intensive Care Medicine , Université de Liège , Liege , Belgium 3. Department of Obstetrics and ‘Exp. Obstetrics’ , Charité–Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin , Germany
Abstract
Abstract
“Placenta Accreta Spectrum” (PAS) is a rare but serious pregnancy condition where the placenta abnormally adheres to the uterine wall and fails to spontaneously release after delivery. When it occurs, PAS is associated with high maternal morbidity and mortality — as PAS management can be particularly challenging. This two-part review summarizes current evidence in PAS management, identifies its most challenging aspects, and offers evidence-based recommendations to improve management strategies and PAS outcomes. The first part of this two-part review highlighted the general anesthetic approach, surgical and interventional management strategies, specialized “centers of excellence,” and multidisciplinary PAS treatment teams. The high rates of PAS morbidity and mortality are often provoked by PAS-associated coagulopathies and peripartal hemorrhage (PPH). Anesthesiologists need to be prepared for massive blood loss, transfusion, and to manage potential coagulopathies. In this second part of this two-part review, we specifically reviewed the current literature pertaining to hemostatic changes, blood loss, transfusion management, and postpartum venous thromboembolism prophylaxis in PAS patients. Taken together, the two parts of this review provide a comprehensive survey of challenging aspects in PAS management for anesthesiologists.
Publisher
Walter de Gruyter GmbH
Subject
Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health
Reference121 articles.
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