Conclusions
The efficiency of this protocol lead to our becoming a reference center
for the management of placenta accreta beyond the borders of our region.
Logistically, the process is made easier because all the operative units
involved are located in the same building.
In these high-risk patients, some elements were very important:
- early prenatal diagnosis;
- referral of patients in qualified hospitals with expertise in the
management of such conditions;
- involvement of a multidisciplinary team;
- right surgical timing;
- proper peri-surgery management.
Using the protocol described, we treated more than 20 patients, some of
them with the most severe forms of PAS disorders (placenta increta and
percreta). We obtained positive results in terms of bleeding, packed red
blood cells used, postoperative sequelae, and UTI admissions. No
patients died. Most patients had a previous cesarean section.
Few procedures were carried out in an emergency regimen, where general
anesthesia was used. Consistent with literature8, they
required the greatest amount of blood products. However, based on our
experience for both elective and emergency surgeries, fibrinogen
administration considerably reduced the need for PRBC. Among those
treated with an elective regimen, blood loss never exceeded 1800 mL.