Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Anesthesia and Intensive Care Medicine, Université de Liège, Liege, Belgium.
J Perinat Med. 2022 Oct 3;51(4):439-454. doi: 10.1515/jpm-2022-0232. Print 2023 May 25.
"Placenta Accreta Spectrum" (PAS) describes abnormal placental adherence to the uterine wall without spontaneous separation at delivery. Though relatively rare, PAS presents a particular challenge to anesthesiologists, as it is associated with massive peripartum hemorrhage and high maternal morbidity and mortality. Standardized evidence-based PAS management strategies are currently evolving and emphasize: "PAS centers of excellence", multidisciplinary teams, novel diagnostics/pharmaceuticals (especially regarding hemostasis, hemostatic agents, point-of-care diagnostics), and novel operative/interventional approaches (expectant management, balloon occlusion, embolization). Though available data are heterogeneous, these developments affect anesthetic management and must be considered in planed anesthetic approaches. This two-part review provides a critical overview of the current evidence and offers structured evidence-based recommendations to help anesthesiologists improve outcomes for women with PAS. This first part discusses PAS management in centers of excellence, multidisciplinary care team, anesthetic approach and monitoring, surgical approaches, patient safety checklists, temperature management, interventional radiology, postoperative care and pain therapy. The diagnosis and treatment of hemostatic disturbances and preoperative prepartum anemia, blood loss, transfusion management and postpartum venous thromboembolism will be addressed in the second part of this series.
“胎盘植入谱系疾病”（PAS）是指胎盘在没有自发分离的情况下异常附着于子宫壁。尽管 PAS 相对罕见，但它给麻醉医生带来了特殊的挑战，因为它与大量围产期出血以及高产妇发病率和死亡率有关。目前正在制定标准化的循证 PAS 管理策略，强调“PAS 卓越中心”、多学科团队、新型诊断/药物（特别是关于止血、止血剂、即时诊断）以及新型手术/介入方法（期待治疗、球囊阻断、栓塞）。尽管现有数据存在异质性，但这些进展影响了麻醉管理，在计划麻醉方法时必须考虑这些因素。这篇两部分的综述提供了当前证据的批判性概述，并提供了结构化的循证建议，以帮助麻醉医生改善 PAS 妇女的结局。这第一部分讨论了卓越中心的 PAS 管理、多学科护理团队、麻醉方法和监测、手术方法、患者安全检查表、体温管理、介入放射学、术后护理和疼痛治疗。第二部分将讨论止血紊乱和产前贫血、出血、输血管理以及产后静脉血栓栓塞症的诊断和治疗。
