Blood Management for Patients with Placenta Accreta
This chapter reviews blood management strategies, discusses patient blood management as it applies to individual patients with accrete, and blood products and their use; proposes hemostatic agents and their use in patients with accreta, and highlights new therapies and how they might be utilized in the future. Maintenance of perfusion/oxygenation and correction of coagulopathy requires adequate support from the blood bank. Obstetric massive hemorrhage protocols should have clear criteria for activation. Early recognition of excessive blood loss is critical. In accreta patients, a baseline coagulation laboratory assessment should be obtained at time of hemorrhage recognition to include platelet count, prothrombin time, partial thromboplastin time, and fibrinogen levels. Patients with placenta accreta often require large-volume transfusion at time of delivery. It is critical that these patients be delivered at centers with well-equipped transfusion services, adequate blood component inventories, and massive transfusion protocols.
