Risk-stratification, resource availability, and choice of surgical location for the management of parturients with abnormal placentation: a survey of United States-based obstetric anesthesiologists

Int J Obstet Anesth. 2018 May;34:56-66. doi: 10.1016/j.ijoa.2018.01.008. Epub 2018 Feb 2.

Abstract

Background: Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services.

Methods: Division chiefs of North American obstetric anesthesiology services were surveyed about their practices and management of parturients with an abnormally adherent placenta.

Results: Eighty-four of 122 chiefs, representing 103 hospital sites, responded to the survey (response rate 69%). Sixty-one percent of respondents agreed that women with preoperative placental imaging that was "suspicious" of placenta accreta represented a lower risk category; all other suggested descriptions fell into a higher risk category. Seventy-nine percent of respondents indicated that lower risk cases were managed on the labor and delivery unit, while 71% indicated that higher risk cases would be managed in the main operating room. Institutions where all cases were managed on the labor and delivery unit had better access to human and technical resources, were less remote from their main operating areas, and promoted neuraxial rather than general anesthesia, even for parturients perceived to be at higher risk.

Conclusions: Obstetric anesthesia leaders identified patients at lower clinical risk and those less likely to require greater resources. Additional resources were available in institutions where all abnormal placentation cases were managed on the labor and delivery unit. Practitioners should consider risk-stratification and resource availability when planning high-risk cases.

Keywords: Abnormally adherent placentation; Anesthesia; Cesarean delivery; Obstetric; Resource allocation.

MeSH terms

  • Adult
  • Anesthesia, Obstetrical / methods*
  • Anesthesiologists*
  • Cesarean Section / statistics & numerical data
  • Delivery Rooms / statistics & numerical data
  • Female
  • Health Care Surveys
  • Health Resources / supply & distribution
  • Humans
  • Operating Rooms / statistics & numerical data
  • Patient Care Planning
  • Placenta Accreta / surgery*
  • Placentation*
  • Practice Patterns, Physicians'
  • Pregnancy
  • Risk Assessment
  • United States