Retrospective analysis of obstetric and anesthetic management of patients with placenta accreta spectrum disorders

Objective: To assess the management and maternal outcomes of placenta accreta spectrum (PAS) disorders. Methods: A retrospective chart review was conducted of patients diagnosed with PAS disorders (placenta creta, increta, or percreta) who were treated at a US tertiary care center between February 1, 2011, and January 31, 2016. Obstetric management, anesthetic management, and maternal outcomes were analyzed. Results: A total of 43 cases were identified; placenta previa was diagnosed among 33 (77%). Median age was 33 years (range 23–42). Median blood loss was 1500 mL (interquartile range 1000–2500); blood loss was greatest among the 10 patients with placenta percreta (3250 mL, interquartile range 2200–6000). Transfusion of blood products was necessary among 14 (33%) patients, with no difference in frequency according to the degree of placental invasion (P=0.107). Surgical complications occurred among 10 (23%) patients. Overall, 30 (70%) patients received combined spinal–epidural plus general anesthesia, 4 (9%) received only general anesthesia, and 9 (21%) underwent surgery with combined spinal–epidural anesthesia. One patient experienced difficult airway and another experienced accidental dural puncture. Conclusion: Placenta previa and accreta coexist in many patients, leading to substantial bleeding related to the degree of myometrial invasion. An interdisciplinary team approach plus the use of combined spinal–epidural anesthesia, transitioning to general anesthesia, were advisable and safe.