A retrospective observational study of placenta accreta spectrum perioperative anaesthesia management in a tertiary care centre: A 25-year experience.

BACKGROUND AND AIMS: Placenta accreta spectrum (PAS) is a life-threatening obstetric condition characterised by abnormal placental adherence, often leading to severe haemorrhage and maternal morbidity. With increasing caesarean deliveries, PAS incidence has risen, requiring structured, multidisciplinary management and tailored anaesthetic strategies. The study was conducted to assess the 25 years of experience in the multidisciplinary and anaesthetic management of PAS at a tertiary care perinatal centre, focusing on clinical outcomes and perioperative strategies.

METHODS

After approval from the institutional ethics committee, this retrospective observational study was conducted, including 129 women diagnosed with PAS from January 1997 to May 2022 at our hospital. Data were extracted from medical and anaesthetic records, covering demographic details, surgical and anaesthetic interventions, estimated blood loss, transfusion requirements, complications, and maternal outcomes. Appropriate statistical tests were applied to assess surgical and anaesthetic management strategies and their impact on patient outcomes over the study period.

RESULTS

Neuraxial anaesthesia was used as the primary modality in 93% of patients, reflecting increased reliance on regional techniques. However, 29% required intraoperative conversion to general anaesthesia due to massive haemorrhage or surgical complexity. The median estimated blood loss was 4015 mL (range: 600-16,010 mL), and 109 patients (84.5%) received blood transfusions. Extensive surgical interventions were needed in 108 cases (83.7%), with bladder injury occurring in 22 cases (17%). Intensive care unit or high-dependency care was required in 79 patients (61.2%). One maternal death (0.8%) was reported, despite high surgical complexity, indicating the effectiveness of coordinated, protocol-driven care.

CONCLUSION

Effective preoperative planning and anaesthetic readiness enable the successful use of neuraxial anaesthesia in PAS. A multidisciplinary approach significantly improves maternal outcomes in this high-risk population.