Placenta accreta spectrum disorder: updates on anesthetic and surgical management strategies

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Maternal-Fetal Medicine

Background:

• Placenta accreta spectrum (PAS) is a significant cause of obstetric hemorrhage and maternal morbidity.
• PAS is the leading indication for peripartum hysterectomy in the United States.
• The incidence of PAS has dramatically increased over the past 40 years.

Purpose of the Study:

• To provide an updated review of Placenta Accreta Spectrum (PAS).
• To outline the critical role of anesthesiologists in managing PAS.
• To cover key aspects from diagnosis to postoperative care for PAS patients.

Main Methods:

• This is a review article.
• Information was gathered on nomenclature, pathophysiology, risk factors, and antenatal detection.
• Management strategies including surgical and anesthetic approaches, intra-operative care, and postoperative plans were compiled.

Main Results:

• PAS incidence has risen from 0.03 to an estimated 0.79-3.11 per 1000 pregnancies.
• Anesthesiologists are increasingly involved in the delivery management of women with suspected PAS.
• Optimal management requires a multidisciplinary approach encompassing pre-operative, intra-operative, and postoperative care.

Conclusions:

• Placenta accreta spectrum (PAS) poses significant risks, necessitating specialized anesthetic and surgical management.
• Early detection, comprehensive pre-operative evaluation, and a coordinated surgical plan are vital for optimizing maternal outcomes.
• Anesthesiologists play a pivotal role in mitigating the severe morbidity associated with PAS.