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):455-467. doi: 10.1515/jpm-2022-0233. Print 2023 May 25.
"Placenta Accreta Spectrum" (PAS) is a rare but serious pregnancy condition where the placenta abnormally adheres to the uterine wall and fails to spontaneously release after delivery. When it occurs, PAS is associated with high maternal morbidity and mortality - as PAS management can be particularly challenging. This two-part review summarizes current evidence in PAS management, identifies its most challenging aspects, and offers evidence-based recommendations to improve management strategies and PAS outcomes. The first part of this two-part review highlighted the general anesthetic approach, surgical and interventional management strategies, specialized "centers of excellence," and multidisciplinary PAS treatment teams. The high rates of PAS morbidity and mortality are often provoked by PAS-associated coagulopathies and peripartal hemorrhage (PPH). Anesthesiologists need to be prepared for massive blood loss, transfusion, and to manage potential coagulopathies. In this second part of this two-part review, we specifically reviewed the current literature pertaining to hemostatic changes, blood loss, transfusion management, and postpartum venous thromboembolism prophylaxis in PAS patients. Taken together, the two parts of this review provide a comprehensive survey of challenging aspects in PAS management for anesthesiologists.
“胎盘植入谱系疾病”（PAS）是一种罕见但严重的妊娠疾病，其胎盘异常附着于子宫壁，在分娩后无法自然释放。当 PAS 发生时，产妇发病率和死亡率很高——因为 PAS 的管理可能特别具有挑战性。这篇两部分综述总结了 PAS 管理的现有证据，确定了其最具挑战性的方面，并提供了循证建议，以改善管理策略和 PAS 结局。这篇两部分综述的第一部分强调了全身麻醉方法、手术和介入管理策略、专门的“卓越中心”以及多学科 PAS 治疗团队。PAS 相关的凝血功能障碍和围产期出血（PPH）常常导致 PAS 发病率和死亡率升高。麻醉师需要为大量出血、输血和潜在的凝血功能障碍做好准备。在这篇两部分综述的第二部分中，我们专门回顾了 PAS 患者止血变化、失血、输血管理和产后静脉血栓栓塞预防的当前文献。总之，这两部分综述为麻醉师提供了 PAS 管理挑战性方面的综合调查。
