Anesthetic Management for Patients with Placenta Accreta Spectrum: A Scoping Review.

Background

Placenta accreta spectrum (PAS) is a condition in which villous tissue pathologically adheres to or invades the uterine wall, which may result in massive bleeding with substantial maternal morbidity and mortality. Despite the constantly increasing prevalence of this condition, an optimal anesthetic management method for this condition has not been fully established. A scoping review of the literature was performed to evaluate current anesthetic management strategies for PAS.

Methods

This review was conducted using the Joanna Briggs Institute (JBI) methodology for scoping reviews. A search of five databases (MEDLINE, EMBASE, CINAHL Complete, Scopus, and Web of Science) was conducted to identify articles containing data on seven prespecified aspects of PAS anesthetic management. Studies that described the management of miscarriage and abortion procedures were excluded.

Results

One hundred thirty articles encompassing numerous approaches to PAS management were included in the final review. Data were mostly extracted from case reports (n = 56) and observational studies (n = 64). The most commonly adopted strategy (n = 62) was the creation of a multidisciplinary team comprising various specialists, including anesthesiologists.

Conclusions

Due to the limited number of interventional studies, the most effective methods of anesthetic management for this condition could not be fully established. However, the safe and effective anesthetic management of PAS patients is feasible. Future research in this field should focus on resolving the identified knowledge gaps and increasing the quality of published studies.