Anesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhage.

PURPOSE OF REVIEW Placenta accreta is one of the leading causes of peripartum hemorrhage. The goal of this article is to review anesthetic management of parturients with placenta accreta and to examine a modern approach to massive peripartum hemorrhage. RECENT FINDINGS The incidence of placenta accreta is rising in parallel with the increased rate of cesarean delivery. If accreta is diagnosed or suspected preoperatively, anesthetic management can be optimized. Even with the best possible management, the blood loss associated with placenta accreta can resemble that of a major trauma. The use of Damage Control Resuscitation strategies to guide transfusion may improve morbidity and mortality. SUMMARY Careful planning and close communication are essential between anesthesiology, obstetric, interventional radiology, gynecologic oncology, blood bank, and specialized surgical teams when taking care of a patient with placenta accreta.