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Liu C, Chu R, Song N, Yang Q, Song X, Li L, Zhang M, Li Y, Xu Y, Li Y, Ma Y. Perinatal outcomes comparison between neuraxial and general anesthesia in pregnant women with placenta accreta spectrum: a multicenter retrospective study. J Anesth 2024; 38:167-178. [PMID: 38345633 DOI: 10.1007/s00540-023-03287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/10/2023] [Indexed: 03/21/2024]
Abstract
PURPOSE We investigated the impact of anesthesia mode on perinatal outcomes in patients with placenta accreta spectrum (PAS) undergoing cesarean delivery and identified factors associated with adverse perinatal events. METHODS The multicenter retrospective analysis was conducted in patients with PAS who delivered at three medical centers. Patients were classified according to whether they received general anesthesia (GA) or neuraxial anesthesia (NA). We compared the basic clinical characteristics of patients in the pre-propensity score matching (PSM) and post-PSM cohorts and identified factors associated with a high risk of adverse maternal outcomes. RESULTS This study included a total of 425 patients, with 307 (72.2%) in the GA group and 118 (27.8%) in the NA group. After PSM, 162 patients were identified for analysis. In the post-matched cohort, the NA group exhibited shorter total operation time (P = 0.030) and postoperative length of hospital stay (P = 0.037). Additionally, the NA group experienced lower intraoperative blood loss (P < 0.001) and received fewer units of transfused packed red blood cells (PRBC) (P < 0.001). Multivariate logistic regression analysis indicated that GA (P < 0.001), emergency cesarean delivery (P = 0.010), vascular lacunae within the placenta (P < 0.001), hypervascularity of uterine-placental margin (P = 0.002), hypervascularity of the cervix (P = 0.014), and balloon placement in the abdominal aorta (P < 0.001) were associated with a high risk of adverse maternal events. CONCLUSION In comparison to GA, cesarean delivery with NA in PAS patients appears to be associated with reduced intraoperative blood loss, PRBC transfusion, operating duration, and postoperative hospital stay.
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Affiliation(s)
- Chenmian Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingsi Road, Jinan, Shandong, People's Republic of China
| | - Ningning Song
- Department of Obstetrics and Gynecology, People's Hospital of Rizhao, Rizhao, Shandong, People's Republic of China
| | - Qiuhong Yang
- Department of Obstetrics and Gynecology, Jinan Maternity and Child Care Hospital, Jinan, Shandong, People's Republic of China
| | - Xiao Song
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, Shandong, People's Republic of China
| | - Liang Li
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Meiling Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
- Department of Obstetrics and Gynecology, Qingdao Women and Children's Hospital, Qingdao, Shandong, People's Republic of China
| | - Yarong Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
- Department of Obstetrics and Gynecology, Jinan Maternity and Child Care Hospital, Jinan, Shandong, People's Republic of China
| | - Yintao Xu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
| | - Yanan Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China.
| | - Yuyan Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China.
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Staniczek J, Manasar-Dyrbuś M, Winkowska E, Skowronek K, Stojko R. Foley Catheter as a Tourniquet for Hemorrhage Prevention during Peripartum Hysterectomy in Patients with Placenta Accreta Spectrum (PAS)-A Hospital-Based Study. Life (Basel) 2023; 13:1774. [PMID: 37629631 PMCID: PMC10455697 DOI: 10.3390/life13081774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Placenta accreta spectrum (PAS) is a clinical entity significantly increasing the risk of a peripartum hemorrhage. Various surgical methods have been described in the literature, which aim to reduce the risk of bleeding, although they often lack reproducibility and have been performed on low numbers of patients. The aim of this study was to evaluate the use of the Foley catheter as a cervical tourniquet during cesarean sections, in patients with PAS. METHODS All patients who underwent peripartum hysterectomy due to PAS in a large single-center registry were included in the present analysis. The general demographics and clinical characteristics of all participants, including blood loss, and maternal and fetal outcomes, were collected and analyzed. RESULTS Twelve participants were included. The mean blood loss was 1200 ± 760 ml during operation and the mean ± SD procedural duration was 89 ± 17 min. The median (Q1-Q3) length of hospital stay post-procedurally was 5 (4-6) days. None of the patients required subsequent urgent surgical procedures after hysterectomy. The median (Q1-Q3) packed red blood cell units transfused in our cohort was 2 (0-3). CONCLUSION Using the Foley catheter as a tourniquet might be an effective method of excessive bleeding prevention in patients with PAS during peripartum hysterectomy.
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Ioscovich A, Weiss A, Shatalin D. The anesthetic approach to a patient with placenta accreta spectrum. Curr Opin Anaesthesiol 2023; 36:263-268. [PMID: 36745077 DOI: 10.1097/aco.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Placenta accreta poses significant risk of morbidity and mortality to a laboring patient. Here we review available treatment options, highlight trends in bleeding prevention and diagnosis that have been shown to improve patient outcome, and provide best practice suggestions. We also discuss the decision-making process for choice of anesthesia, as it is not based on a gold-standard paradigm. RECENT FINDINGS The use of resuscitative endovascular balloon occlusion of the aorta has been gaining popularity around the world. It has been shown to cause an equivocal reduction in perioperative bleeding in placenta accreta spectrum (PAS), reduce the rate of hysterectomies, and is a safe and relatively easy technique. There are other invasive radiology techniques that have also proven to be beneficial in bleeding prevention: balloon occlusion of hypogastric arteries intraoperatively, internal iliac artery embolization, and intraoperative ligation of the hypogastric or uterine arteries. SUMMARY Optimal management of PAS begins with early and definitive diagnosis. A multidisciplinary approach along with preparation of special equipment and the use of a check-list maximize the chance for success. Anesthesia could be done with all types of regional or under general, considering case-by-case factors but most importantly choosing according to the institution's best facility and skill.
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Affiliation(s)
- Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with The Hebrew University, Jerusalem, Israel
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