Journal
CLINICAL OBSTETRICS AND GYNECOLOGY
Volume 61, Issue 4, Pages 808-827Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/GRF.0000000000000403
Keywords
obstetric anesthesia; placenta accreta; obstetric hemorrhage; massive transfusion; neuraxial; anesthesia; breastfeeding; preoperative evaluation
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Placenta accreta spectrum is becoming more common and is the most frequent indication for peripartum hysterectomy. Management of cesarean delivery in the setting of a morbidly adherent placenta has potential for massive hemorrhage, coagulopathies, and other morbidities. Anesthetic management of placenta accreta spectrum presents many challenges including optimizing surgical conditions, providing a safe and satisfying maternal delivery experience, preparing for massive hemorrhage and transfusion, preventing coagulopathies, and optimizing postoperative pain control. Balancing these challenging goals requires meticulous preparation with a thorough preoperative evaluation of the parturient and a well-coordinated multidisciplinary approach in order to optimize outcomes for the mother and fetus.
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