title: Anaesthetic management of placenta accreta: use of a pre-operative high and low suspicion classification.
abstract: Placenta accreta may be suspected prior to surgery, but the actual diagnosis is only confirmed at surgery. This prospective and observational study was performed to assess whether preparations should be made for potential massive blood loss prior to Caesarean surgery in all patients with suspected placenta accreta. Patients were classified as high or low suspicion for placenta accreta based on ultrasonography and clinical factors. Among 28 suspected cases of placenta accreta, diagnosis was confirmed at surgery in 50% (12/17 high and 2/11 low suspicion) cases. Hysterectomy was only performed in the 12 high suspicion patients with placenta accreta (p < 0.001). High suspicion patients required more blood transfusions: mean(SD) 6.5 (7.0) units vs 1.09 (1.1) units, p = 0.017. Anaesthetists should be prepared for major haemorrhage in all cases of suspected placenta accreta, although use of a system to grade level of suspicion may identify those at greater risk.
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Hadassah Hebrew University Medical Centre, Jerusalem, Israel, POB 12000. weinigerc@softhome.net
authors.forename: C F
authors.initials: CF
authors.lastname: Weiniger
authors.forename: T
authors.initials: T
authors.lastname: Elram
authors.forename: Y
authors.initials: Y
authors.lastname: Ginosar
authors.forename: D
authors.initials: D
authors.lastname: Mankuta
authors.forename: C
authors.initials: C
authors.lastname: Weissman
authors.forename: Y
authors.initials: Y
authors.lastname: Ezra
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D001803:Blood Transfusion; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010921:Placenta Accreta / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011183:Postoperative Complications; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors