Abstract
The rising in placenta accreta spectrum (PAS) incidence, highlights the need for critical
care allotment for these patients. Due to risk for hemorrhage and possible hemorrhagic
shock requiring blood product transfusion, hemodynamic instability and risk of end-organ
damage, having an intensive care unit (ICU) with surgical expertise (surgical ICU
or equivalent based on institutional resources) is highly recommended. Intensive care
units physicians and nurses should be familiarized with intraoperative anesthetic
and surgical techniques as well as obstetrics physiologic changes to provide postpartum
management of PAS. Validated tools such of bedside point of care ultrasound and viscoelastic
tests such as thromboelastogram/rotational thromboelastometry (TEG/ROTEM) are clinically
useful in the assessment of hemodynamic status (shock diagnosis, assessment of both
fluid responsiveness and tolerance) and transfusion guidance (in patients requiring
massive transfusion as opposed to tranditional hemostatic resuscitation) respectively.
The future of PAS management lies in the collaborative and multidisciplinary environment.
We recommend that women with high suspicion or a confirmed PAS should have a preoperative
plan in place and be managed in a tertiary center who is experienced in managing surgically
complex cases.
Key Points
-
The rising in placenta accreta spectrum incidence highlights the need for critical
care expertise.
-
Emerging tools such as point-of-care ultrasound and thromboelastography/rotational
thromboelastometry represent new avenues for real time optimization of hemodynamic
and hematological care of patients with PAS.
-
Patients with PAS should be referred to a tertiary center having an intensive care
unit (ICU) with surgical expertise (or equivalent based on institutional resources).
Keywords
Placenta accreta spectrum - intensvie care unit - point of care ultrasound - TEG -
ROTEM
