PDF herunterladen
Am J Perinatol 2023; 40(09): 988-995
DOI: 10.1055/s-0043-1761638
PAS Series Article
Review Article

Critical Care in Placenta Accreta Spectrum Disorders—A Call to Action

Cesar R. Padilla
1   Division of Obstetric Anesthesiology, Stanford University School of Medicine, Stanford, California
,
Amir A. Shamshirsaz
2   Department of Obstetrics and Gynecology/Surgical Critical Care Texas Children's Hospital, Baylor College of Medicine, Texas
,
Sarah R. Easter
3   Department of Obstetrics and Gynecology/Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Phillip Hess
4   Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Carly Smith
5   Department of Anesthesiology and Pain Management, Anesthesiology Institute, Cleveland Clinic, Ohio
,
Nadir El Sharawi
6   Division of Obstetrical Anesthesia, University of Arkansas for Medical Sciences, Fayetteville, Arkansas
,
Adam T. Sandlin
7   Division of Maternal-Fetal Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

The rising in placenta accreta spectrum (PAS) incidence, highlights the need for critical care allotment for these patients. Due to risk for hemorrhage and possible hemorrhagic shock requiring blood product transfusion, hemodynamic instability and risk of end-organ damage, having an intensive care unit (ICU) with surgical expertise (surgical ICU or equivalent based on institutional resources) is highly recommended. Intensive care units physicians and nurses should be familiarized with intraoperative anesthetic and surgical techniques as well as obstetrics physiologic changes to provide postpartum management of PAS. Validated tools such of bedside point of care ultrasound and viscoelastic tests such as thromboelastogram/rotational thromboelastometry (TEG/ROTEM) are clinically useful in the assessment of hemodynamic status (shock diagnosis, assessment of both fluid responsiveness and tolerance) and transfusion guidance (in patients requiring massive transfusion as opposed to tranditional hemostatic resuscitation) respectively. The future of PAS management lies in the collaborative and multidisciplinary environment. We recommend that women with high suspicion or a confirmed PAS should have a preoperative plan in place and be managed in a tertiary center who is experienced in managing surgically complex cases.

Key Points

  • The rising in placenta accreta spectrum incidence highlights the need for critical care expertise.

  • Emerging tools such as point-of-care ultrasound and thromboelastography/rotational thromboelastometry represent new avenues for real time optimization of hemodynamic and hematological care of patients with PAS.

  • Patients with PAS should be referred to a tertiary center having an intensive care unit (ICU) with surgical expertise (or equivalent based on institutional resources).

Keywords

Placenta accreta spectrum - intensvie care unit - point of care ultrasound - TEG - ROTEM


Publikationsverlauf

Artikel online veröffentlicht:
19. Juni 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Belfort MA. Publications Committee, Society for Maternal-Fetal Medicine. Placenta accreta. Am J Obstet Gynecol 2010; 203 (05) 430-439
    CrossrefPubMedGoogle Scholar
  • 2 Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221 (03) 208-218
    CrossrefPubMedGoogle Scholar
  • 3 American College of Obstetricians and Gynecologists. Levels of maternal care. Obstetric Care Consensus No. 9. Obstet Gynecol 2019; 134 (02) e41-e55
    CrossrefPubMedGoogle Scholar
  • 4 Shamshirsaz AA, Fox KA, Erfani H. et al. Coagulopathy in surgical management of placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol 2019; 237: 126-130
    CrossrefPubMedGoogle Scholar
  • 5 Eller AG, Bennett MA, Sharshiner M. et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117 (2 Pt 1): 331-337
    CrossrefPubMedGoogle Scholar
  • 6 Shamshirsaz AA, Fox KA, Salmanian B. et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015; 212 (02) 218.e1-218.e9
    CrossrefPubMedGoogle Scholar
  • 7 Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177 (01) 210-214
    CrossrefPubMedGoogle Scholar
  • 8 O'Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 1996; 175 (06) 1632-1638
    CrossrefPubMedGoogle Scholar
  • 9 Wagner JL, White RS, Mauer EA, Pryor KO, Kjaer K. Impact of anesthesiologist's fellowship status on the risk of general anesthesia for unplanned cesarean delivery. Acta Anaesthesiol Scand 2019; 63 (06) 769-774
    CrossrefPubMedGoogle Scholar
  • 10 Markley JC, Farber MK, Perlman NC, Carusi DA. Neuraxial anesthesia during cesarean delivery for placenta previa with suspected morbidly adherent placenta: a retrospective analysis. Anesth Analg 2018; 127 (04) 930-938
    CrossrefPubMedGoogle Scholar
  • 11 Romero-Bermejo FJ, Ruiz-Bailen M, Guerrero-De-Mier M, Lopez-Alvaro J. Echocardiographic hemodynamic monitoring in the critically ill patient. Curr Cardiol Rev 2011; 7 (03) 146-156
    CrossrefPubMedGoogle Scholar
  • 12 Cecconi M, De Backer D, Antonelli M. et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014; 40 (12) 1795-1815
    CrossrefPubMedGoogle Scholar
  • 13 Volpicelli G, Mussa A, Garofalo G. et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med 2006; 24 (06) 689-696
    CrossrefPubMedGoogle Scholar
  • 14 Cornette J, Laker S, Jeffery B. et al. Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review. Ultrasound Obstet Gynecol 2017; 49 (01) 25-31
    CrossrefPubMedGoogle Scholar
  • 15 Keene DD, Nordmann GR, Woolley T. Rotational thromboelastometry-guided trauma resuscitation. Curr Opin Crit Care 2013; 19 (06) 605-612
    PubMedGoogle Scholar
  • 16 Theusinger OM, Schröder CM, Eismon J. et al. The influence of laboratory coagulation tests and clotting factor levels on Rotation Thromboelastometry (ROTEM) during major surgery with hemorrhage. Anesth Analg 2013; 117 (02) 314-321
    CrossrefPubMedGoogle Scholar
  • 17 Lier H, Vorweg M, Hanke A, Görlinger K. Thromboelastometry guided therapy of severe bleeding. Essener Runde algorithm. Hamostaseologie 2013; 33 (01) 51-61
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 18 Wikkelsø A, Wetterslev J, Møller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev 2016; 2016 (08) CD007871
    PubMedGoogle Scholar
  • 19 McNamara H, Kenyon C, Smith R, Mallaiah S, Barclay P. Four years' experience of a ROTEM -guided algorithm for treatment of coagulopathy in obstetric haemorrhage. Anaesthesia 2019; 74 (08) 984-991
    CrossrefPubMedGoogle Scholar
  • 20 Armstrong S, Fernando R, Ashpole K, Simons R, Columb M. Assessment of coagulation in the obstetric population using ROTEM thromboelastometry. Int J Obstet Anesth 2011; 20 (04) 293-298
    CrossrefPubMedGoogle Scholar
  • 21 de Lange NM, van Rheenen-Flach LE, Lancé MD. et al. Peri-partum reference ranges for ROTEM thromboelastometry. Br J Anaesth 2014; 112 (05) 852-859
    CrossrefPubMedGoogle Scholar
  • 22 Huissoud C, Carrabin N, Benchaib M. et al. Coagulation assessment by rotation thrombelastometry in normal pregnancy. Thromb Haemost 2009; 101 (04) 755-761
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 23 Oudghiri M, Keita H, Kouamou E. et al. Reference values for rotation thromboelastometry (ROTEM) parameters following non-haemorrhagic deliveries. Correlations with standard haemostasis parameters. Thromb Haemost 2011; 106 (01) 176-178
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 24 Lee J, Eley VA, Wyssusek KH. et al. Baseline parameters for rotational thromboelastometry (ROTEM) in healthy women undergoing elective caesarean delivery: a prospective observational study in Australia. Int J Obstet Anesth 2019; 38: 10-18
    CrossrefPubMedGoogle Scholar
  • 25 Anderson L, Quasim I, Steven M. et al. Interoperator and intraoperator variability of whole blood coagulation assays: a comparison of thromboelastography and rotational thromboelastometry. J Cardiothorac Vasc Anesth 2014; 28 (06) 1550-1557
    CrossrefPubMedGoogle Scholar
  • 26 Pachtman S, Koenig S, Meirowitz N. Detecting pulmonary edema in obstetric patients through point of care lung ultrasonography. Obstet Gynecol 2017; 129 (03) 525-529
    CrossrefPubMedGoogle Scholar
  • 27 Thompson BT, Chambers RC, Liu KD. Acute respiratory distress syndrome. N Engl J Med 2017; 377 (06) 562-572
    CrossrefPubMedGoogle Scholar
  • 28 Toy P, Popovsky MA, Abraham E. et al; National Heart, Lung and Blood Institute Working Group on TRALI. Transfusion-related acute lung injury: definition and review. Crit Care Med 2005; 33 (04) 721-726
    CrossrefPubMedGoogle Scholar
  • 29 Murphy EL, Kwaan N, Looney MR. et al; TRALI Study Group. Risk factors and outcomes in transfusion-associated circulatory overload. Am J Med 2013; 126 (04) 357.e29-357.e38
    CrossrefPubMedGoogle Scholar
  • 30 Bonnet MP, Mignon A, Mazoit JX, Ozier Y, Marret E. Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: a systematic review. Eur J Pain 2010; 14 (09) 894.e1-894.e9
    CrossrefPubMedGoogle Scholar
  • 31 Salicath JH, Yeoh EC, Bennett MH. Epidural analgesia versus patient-controlled intravenous analgesia for pain following intra-abdominal surgery in adults. Cochrane Database Syst Rev 2018; 8 (08) CD010434
    PubMedGoogle Scholar
  • 32 Sutton CD, Carvalho B. Optimal pain management after cesarean delivery. Anesthesiol Clin 2017; 35 (01) 107-124
    CrossrefPubMedGoogle Scholar
  • 33 Sharawi N, Carvalho B, Habib AS, Blake L, Mhyre JM, Sultan P. A systematic review evaluating neuraxial morphine and diamorphine-associated respiratory depression after cesarean delivery. Anesth Analg 2018; 127 (06) 1385-1395
    CrossrefPubMedGoogle Scholar
  • 34 Bauchat JR, Weiniger CF, Sultan P. et al. Society for Obstetric Anesthesia and Perinatology Consensus Statement: monitoring recommendations for prevention and detection of respiratory depression associated with administration of neuraxial morphine for cesarean delivery analgesia. Anesth Analg 2019; 129 (02) 458-474
    CrossrefPubMedGoogle Scholar
  • 35 Cobb B, Liu R, Valentine E, Onuoha O. Breastfeeding after anesthesia: a review for anesthesia providers regarding the transfer of medications into breast milk. Transl Perioper Pain Med 2015; 1 (02) 1-7
    PubMedGoogle Scholar
  • 36 van den Anker JN. Is it safe to use opioids for obstetric pain while breastfeeding?. J Pediatr 2012; 160 (01) 4-6
    CrossrefPubMedGoogle Scholar
  • 37 Hendrickson RG, McKeown NJ. Is maternal opioid use hazardous to breast-fed infants?. Clin Toxicol (Phila) 2012; 50 (01) 1-14
    CrossrefPubMedGoogle Scholar