{
    "abstract": "Placenta accrete spectrum (PAS) is a significant risk factor for postpartum hemorrhage and effective blood product management is critical in ensuring patient safety. In PAS patients undergoing cesarean section (CS) blood transfusion management guided by the combined clinical experience of the anesthesiologist and surgeon with point-of-care coagulation testing appears safe and effective. We describe and evaluate our experience and identify potential areas for improvement with blood product management in this patient population.\nA retrospective chart review of peri-operative demographic, anesthetic, and obstetric data was conducted for all patients with PAS undergoing CS between 2012 and 2018 at our center. To facilitate a practical evaluation of blood product management, we divided patients into two groups based on the severity of bleeding.\nA total of 221 parturients with PAS underwent CS, with 133 in group 1 requiring excessive amounts of transfusion and 88 in group 2 requiring management similar to other uncomplicated CS cases. There were no deaths or instances of disseminated intravascular coagulation, and intensive care unit admission occurred in five cases (2.2%). Patients in group 1 had higher mean nadir values of intra-operative hemoglobin and platelet count. We observed a high rate of missing data for peri-operative measurement of lactate and fibrinogen, PAS grade documentation, and temperature monitoring.\nGiven no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.",
    "authors": [
        {
            "affiliation": "Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel. Electronic address: amir.zabida@uhn.ca.",
            "firstname": "A",
            "initials": "A",
            "lastname": "Zabida"
        },
        {
            "affiliation": "Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel.",
            "firstname": "G",
            "initials": "G",
            "lastname": "Zahavi"
        },
        {
            "affiliation": "Department of Anaesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada.",
            "firstname": "J",
            "initials": "J",
            "lastname": "Bartoszko"
        },
        {
            "affiliation": "Department of Anesthesiology, Hospital Universitario San Ignacio, Faculty of Medicine, Pontificia Universidad Javeriana, Bogot\u00e1, Colombia.",
            "firstname": "M",
            "initials": "M",
            "lastname": "Ot\u00e1lora-Esteban"
        },
        {
            "affiliation": "Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel.",
            "firstname": "J",
            "initials": "J",
            "lastname": "Weinstein"
        },
        {
            "affiliation": "Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel.",
            "firstname": "J",
            "initials": "J",
            "lastname": "Frogel"
        },
        {
            "affiliation": "Blood Bank, Sheba Medical Centre, Tel-Hashomer, Israel.",
            "firstname": "L",
            "initials": "L",
            "lastname": "Miller"
        },
        {
            "affiliation": "Josef Buchman Gynecology and Maternity Centre, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.",
            "firstname": "E",
            "initials": "E",
            "lastname": "Sivan"
        },
        {
            "affiliation": "Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel.",
            "firstname": "D",
            "initials": "D",
            "lastname": "Orkin"
        },
        {
            "affiliation": "Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel.",
            "firstname": "I",
            "initials": "I",
            "lastname": "Dolgoker"
        },
        {
            "affiliation": "Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel.",
            "firstname": "H",
            "initials": "H",
            "lastname": "Berkenstadt"
        }
    ],
    "conclusions": "Given no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.",
    "copyrights": "Copyright \u00a9 2023 Elsevier Ltd. All rights reserved.",
    "doi": "10.1016/j.ijoa.2023.103904",
    "journal": "International journal of obstetric anesthesia",
    "keywords": [
        "Blood product management",
        "Overtransfusion",
        "Placenta accreta spectrum",
        "Point of care coagulation testing",
        "Quality improvement"
    ],
    "methods": null,
    "publication_date": "2023-06-27",
    "pubmed_id": "37364347",
    "results": "A total of 221 parturients with PAS underwent CS, with 133 in group 1 requiring excessive amounts of transfusion and 88 in group 2 requiring management similar to other uncomplicated CS cases. There were no deaths or instances of disseminated intravascular coagulation, and intensive care unit admission occurred in five cases (2.2%). Patients in group 1 had higher mean nadir values of intra-operative hemoglobin and platelet count. We observed a high rate of missing data for peri-operative measurement of lactate and fibrinogen, PAS grade documentation, and temperature monitoring.",
    "title": "Improving blood product management in placenta accreta patients with severe bleeding: institutional experience.",
    "xml": "<Element 'PubmedArticle' at 0x788506fbab60>"
}