Riveros-Perez Efrain, Wood Cristina
Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.
Int J Gynaecol Obstet. 2018 Mar;140(3):370-374. doi: 10.1002/ijgo.12366. Epub 2017 Nov 23.
To assess the management and maternal outcomes of placenta accreta spectrum (PAS) disorders.
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.
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.
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.
评估胎盘植入谱系障碍（PAS）的管理及孕产妇结局。
对2011年2月1日至2016年1月31日在美国一家三级医疗中心接受治疗的诊断为PAS障碍（胎盘粘连、胎盘植入、穿透性胎盘植入）的患者进行回顾性病历审查。分析产科管理、麻醉管理及孕产妇结局。
共确定43例病例；33例（77%）诊断为前置胎盘。中位年龄为33岁（范围23 - 42岁）。中位失血量为1500 mL（四分位间距1000 - 2500）；10例穿透性胎盘植入患者失血量最大（3250 mL，四分位间距2200 - 6000）。14例（33%）患者需要输注血液制品，根据胎盘侵入程度，输血频率无差异（P = 0.107）。10例（23%）患者发生手术并发症。总体而言，30例（70%）患者接受腰麻 - 硬膜外联合麻醉加全身麻醉，4例（9%）仅接受全身麻醉，9例（21%）接受腰麻 - 硬膜外联合麻醉手术。1例患者出现气道困难，另1例发生意外硬膜穿刺。
许多患者前置胎盘与胎盘植入并存，导致与子宫肌层侵入程度相关的大量出血。采用多学科团队方法并使用腰麻 -硬膜外联合麻醉，必要时转换为全身麻醉是可取且安全的。
