Transfusion Medicine in a Multidisciplinary Approach to Morbidly Adherent Placenta: Preparing for and Preventing the Worst.

TitleTransfusion Medicine in a Multidisciplinary Approach to Morbidly Adherent Placenta: Preparing for and Preventing the Worst.
Publication TypeJournal Article
Year of Publication2018
AuthorsDeSimone RA, Leung WK, Schwartz J
JournalTransfus Med Rev
Volume32
Issue4
Pagination244-248
Date Published2018 10
ISSN1532-9496
KeywordsAntifibrinolytic Agents, Blood Component Transfusion, Blood Transfusion, Cesarean Section, Female, Hemorrhage, Humans, Interdisciplinary Communication, Placenta, Placenta Accreta, Postpartum Hemorrhage, Postpartum Period, Pregnancy, Preoperative Period, Retrospective Studies, Transfusion Medicine
Abstract

The increasing incidence of placenta accreta has paralleled the rise in its greatest risk factor: cesarean delivery. In placenta accreta, the abnormal invasion of the chorionic villi into the myometrium prevents separation of the placenta at delivery, and the myometrium is unable to contract to prevent hemorrhage. Spontaneous uterine rupture and hemoperitoneum may also occur in the setting of placenta percreta. The average blood loss during a delivery complicated by placenta accreta is 2 to 5 L, compared to less than 0.5 L for a normal spontaneous vaginal delivery and less than 1 L for a cesarean delivery. Transfusion support for these patients, including preoperative blood component planning, is challenging for the transfusion service, and there is no consensus on how transfusion services should prepare for such cases. Herein, we review the value of a multidisciplinary approach in minimizing and supporting maternal hemorrhage in placenta accreta, predictors of hemorrhage, blood product preparation, potential strategies to limit blood loss, and intraoperative management considerations. We also highlight future opportunities and challenges in this unique group of patients.

DOI10.1016/j.tmrv.2018.05.007
Alternate JournalTransfus Med Rev
PubMed ID30025661
Related Faculty: 
Robert DeSimone, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
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