Title: Placenta Accreta: Anaesthesia Management
Authors: Dr Rashmi Bengali, Dr Tushar Patil, Dr Bhaskar Auralkar
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.55
Abstract
Haemorrhagic emergencies always pose a challenge to anaesthetist. Though multidisciplinary approach to treat such emergencies is a cornerstone of management, knowledge of the disease process and the management plan decides the outcome. One such life threatening emergency is placenta accreta. The incidence is approximately 1 in 1000 deliveries. Uterine scar caused by previous caesarean section for placenta previa puts the patients in high risk zone for placenta accreta. Diagnosis is generally done by grey scale ultrasonography while magnetic resonance imaging may be helpful in ambiguous cases. Antenatal diagnosis seems to be a key factor in optimizing maternal outcome. Elective caesarean hysterectomy with placenta in situ is recommended treatment to avoid the haemorrhagic morbidity. A prenatal screening for cell-free fetal DNA, placental mRNA, and DNA microarray can play crucial role in better understanding of placental invasion.
The current review discusses the epidemiology, predisposing factors, pathogenesis, diagnostic methods, clinical implications and management options of this condition.
Keywords: Placenta accreta, obstetric hysterectomy, Haemorrhage, Massive blood transfusion.
References
1. S. Wu, M. Kocherginsky, and J. U. Hibbard, “Abnormal placentation: twenty-year analysis,” American Journal of Obstetrics and Gynecology, vol. 192, no. 5, pp. 1458–1461, 2005.
2. D. A. Miller, J. A. Chollet, and T. M. Goodwin, “Clinical risk factors for placenta previa-placenta accreta,” American Journal of Obstetrics and Gynecology,v.177,no 1, pp.210–214, 1997
3. R. Faranesh, R. Shabtai, S. Eliezer, and S. Raed, “Suggested approach for management of placenta percreta invading the urinary bladder,” Obstetrics and Gynecology, vol. 110, no. 2, pp. 512–515, 2007,
4. O’Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies.
Am J ObstetGynecol 1996;175:1632–8
5. Hughes EC, editor. Obstetric-gynecologic terminology: with section on neonatology and glossary on congenital anomalies. Philadelphia (PA): F.A. Davis; 1972
6. Garmi, S. Goldman, E. Shalev, and R. Salim, “The effects of decidual injury on the invasion potential of trophoblastic cells,” Obstetrics and Gynecology, vol. 117, no. 1, pp. 55–59, 2011.
7. J.-J. Tseng and M.-M. Chou, “Differential expression of growth-, angiogenesis- and invasion-related factors in the development of placenta accreta,” Taiwanese Journal of Obstetrics and Gynecology, vol. 45, no. 2, pp. 100–106, 2006
8. P. Tantbirojn, C. P. Crum, and M. M. Parast, “Pathophysiology of placenta creta: the role of decidua and extravilloustrophoblast,” Placenta, vol. 29, no. 7, pp. 639–645, 2008 .
9. J.-J. Tseng and M.-M. Chou, “Differential expression of growth-, angiogenesis- and invasion-related factors in the development of placenta accreta,” Taiwanese Journal of Obstetrics and Gynecology, vol. 45, no. 2, pp. 100–106, 2006].
10. M. Cohen, C. Wuillemin, O. Irion, and P. Bischof, “Role of decidua in trophoblastic invasion,”Neuroendocrinology Letters, vol. 31, no. 2, pp. 193–197, 2010]
11. Hudon L, Belfort MA, Broome DR. Diagnosis and management of placenta percreta: a review. ObstetGynecolSurv 1998;53:509–17
12. Al-Serehi A, Mhoyan A, Brown M, Benirschke K, Hull A, Pretorius DH. Placenta accreta: an association with fibroids and Asherman syndrome. J Ultrasound Med 2008;27:1623–8)
13. Hamar BD, Wolff EF, Kodaman PH, Marcovici I. Premature rupture of membranes, placenta increta, and hysterectomy in a pregnancy following endometrial ablation. J Perinatol 2006;26:135–7,
14. Pron G, Mocarski E, Bennett J, Vilos G, Common A, Vanderburgh L. Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial. Ontario UFE Collaborative Group.ObstetGynecol 2005;105:67–76.
15. Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006;108:573–81. [PubMed] [Obstetrics &Gynecology]
16. Comstock CH, Love JJ Jr, Bronsteen RA, Lee W, Vettraino IM, Huang RR, et al. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J ObstetGynecol 2004;190:1135
17. Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. ObstetGynecol2006;).
18. D. Levine, C. A. Hulka, J. Ludmir, W. Li, and R. R. Edelman, “Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging,” Radiology, vol. 205, no. 3, pp. 773–776, 1997.
19. Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, Froelich JW, et al. ACR guidance document for safe MR practices: 2007. ACR Blue Ribbon Panel on MR Safety. AJR Am J Roentgenol 2007;188:1447–74
20. J. C. Shih, J. M.P. Jaraquemada, Y. N. Su et al., “Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques,”Ultrasound in Obstetrics and Gynecology, vol. 33, no. 2, pp. 193–203, 2009
21. B. K. Robinson and W. A. Grobman, “Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta,” Obstetrics and Gynecology, vol. 116, no. 4, pp. 835–842, 2010.
22. G. Eller, M. A. Bennett, M. Sharshiner et al., “Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care,” Obstetrics and Gynecology, vol. 117, no. 2, pp. 331–337, 2011.
23. D. H. Chestnut, D. M. Dewan, L. F. Redick, D. Caton, and F. J. Spielman, “Anesthetic management for obstetric hysterectomy: a multi-institutional study,” Anesthesiology, vol. 70, no. 4, pp. 607–610, 1989
24. J. L. Hawkins, J. F. Arens, B. A. Bucklin et al., “Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on obstetric anesthesia,” Anesthesiology, vol. 106, no. 4, pp. 843–863, 2007 .
25. Schochl H, Nienaber U, Hofer G, et al. Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM1)-guided administration of fibrinogen concentrate and prothrombin complex concentrate Critical Care 2010; 14:R55
26. R. Washecka and A. Behling, “Urologic complications of placenta percreta invading the urinary bladder: a case report and review of the literature,” Hawaii Medical Journal, vol. 61, no. 4, pp. 66–69, 2002
27. S. Timmermans, A. C. Van Hof, and J. J. Duvekot, “Conservative management of abnormally invasive placentation,” Obstetrical and Gynecological Survey, vol. 62, no. 8, pp. 529–539, 2007