Double-Block for Cesarean Section and Hysterectomy in a Patient with Severe Placenta Accreta Spectrum: Are Neuraxial Blocks a Better Option Nowadays? A Case Report
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Abstract
The Placenta Accreta Spectrum is an anomaly in the placenta that adheres to the uterus and fails to separate from it at delivery, which can lead to massive hemorrhage. For the anesthesiologist, the decision between general anesthesia (risks of pulmonary aspiration and difficult airway) or neuraxial block (worsening of hemorrhagic shock) is challenging. Vascular surgeons have helped reduce the bleeding for many years, and some techniques are more efficient. Is this the moment to prefer a neuraxial block? We expect to show that both methods are possible, but since the advent of vascular devices, neuraxial blocks are less harmful as these devices can reduce bleeding rates.
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References
Enste R, Cricchio P, Dewandre PY, Braun T, Leonards CO, Niggemann P. Placenta accreta spectrum part I: anesthesia consi-derations based on an extended review of the literature. J Perinat Med. 2022 May 25;0(0).
Ioscovich A, Weiss A, Shatalin D. The anesthetic approach to a patient with placenta accreta spectrum. Curr Opin Anaesthesiol [Internet]. 2023 Jun;36(3):263–8. Available from: https://journals.lww.com/10.1097/ACO.0000000000001242
Reale SC, Farber MK. Management of patients with suspected placenta accreta spectrum. BJA Educ. 2022;22:43–51.
Jauniaux E, Zheng W, Yan J. Confirming the diagnosis and classifying placenta accreta spectrum (PAS) disorders: Minutes of 2020 online international workshop on PAS in Beijing. Matern Fetal Med. 2021;3:229–31.
Nankali A, Salari N, Kazeminia M, Mohammadi M, Rasoulinya S, Hosseinian-Far M. The effect of prophylactic internal iliac artery balloon occlusion in patients with placenta previa or placental accreta spectrum: a systematic review and meta‐analysis. Reprod Biol Endocrinol. 2021 Dec 1;19(1).
Warrick CM, Rollins MD. Peripartum anesthesia considerations for placenta accreta [Internet]. 2018. Available from: http://journals.lww.com/clinicalobgyn
Warrick CM, Markley JC, Farber MK, Balki M, Katz D, Hess PE, et al. Placenta accreta spectrum disorders: knowledge gaps in anesthesia care. Obstet Anesth Dig. 2023 Mar;43(1):28–9.
Liu C, Yang D, Qu H, Guo Y, Liu L. Efficacy and safety of prophylactic abdominal aortic balloon occlusion versus internal iliac arterial balloon occlusion for placenta accreta spectrum disorder: a systematic review and meta-analysis. Clin Imaging. 2021;78:250–5.
Ioffe YJM, Burruss S, Yao R, Tse B, Cryer A, Mukherjee K, et al. When the balloon goes up, blood transfusion goes down: A pilot study of REBOA in placenta accreta spectrum disorders. Trauma Surg Acute Care Open. 2021 Aug 13;6(1).
Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2020;2020.
de Freitas FGR, Hammond N, Li Y, de Azevedo LCP, Cavalcanti AB, Taniguchi L, et al. Resuscitation fluid practices in Brazilian intensive care units: A secondary analysis of Fluid-TRIPS. Rev Bras Ter Intensiva. 2021 Apr 1;33(2):206–18.