A review of current anesthetic concerns and concepts for cesarean hysterectomy.

PURPOSE OF REVIEW: Peripartum hemorrhage still remains a significant source of maternal morbidity and mortality worldwide. Abnormal placentation is one of the leading causes of peripartum hemorrhage.

RECENT FINDINGS: The incidence of abnormal placentation is increasing secondary to the increased incidence of cesarean section. The main forms of abnormal placentation include placenta accreta, placenta previa and low-lying placenta. Historically placenta accreta was an incidental finding at the time of delivery and was associated with high maternal morbidity and mortality. The development of new imaging techniques such as magnetic resonance imaging and transvaginal color Doppler sonography has allowed antenatal diagnosis of this condition and elective preoperative planning of the obstetric and anesthetic management of these patients. Optimum management for most cases requires elective cesarean hysterectomy, performed ideally at about 34 weeks' gestation.

SUMMARY: The present article is an update on the state-of-the art multidisciplinary management of parturients undergoing cesarean hysterectomy with special emphasis on anesthetic considerations. It summarizes the prevention, management and treatment of obstetric hemorrhages in parturients with abnormal placentation and highlights recent advances and developments. The obstetrician and the obstetric anesthesiologist must know, on the spot, how to deal with abnormal placentation-related peripartum bleeding. A multidisciplinary approach results in best outcomes.