414 Multidisciplinary management facilitates the application of neuraxial anesthesia in placenta accreta spectrum

Abstract

The concern about massive hemorrhage frequently associated with placenta accreta spectrum (PAS) disorder prompts the routine use of general anesthesia (GA) at many centers. In this study, we aimed to describe the effects of establishing a fixed multidisciplinary team (PAS team) on anesthetic practices and clinical results. In this before-and-after study, we included patients with prenatal PAS suspicion treated between December 2011 and December 2019. We evaluated the clinical results and anesthetic techniques used before (Group 1) and after (Group 2) a PAS team was established in April 2016 Eighty-one patients with prenatal PAS suspicion (by US or MRI) were included in the analysis (Table 1). NA was used more frequently after the PAS team was established, as it was used in 23.3% of group 1 patients and 76.4% of group 2 patients. Likewise, the frequency of conversion to GA after initial management with NA decreased from 14.3% in group 1 to 7.7% in group 2. Surgical time (275 vs 190 minutes), intraoperative bleeding (2000 vs 1480 mL) and complications related to surgery (36 vs 17%) were lower in group 2. All this despite a similar frequency of percreta (16 vs 15%), S2 uterine involvement (43 vs 45%) and scheduled surgery (76 vs 66%) The establishment of a PAS team is related to increased use of NA during the management of PAS patients. NA is safe to use during the surgical treatment of PAS, even in severe cases.