Perioperative Nursing Care : Elective Caesarean Hysterectomy in Pregnant Women with Placenta Accreta Spectrum

Abstract

Placenta accreta spectrum (PAS) is a severe obstetric complication and a major cause of postpartum hemorrhage,emergency hysterectomy,and maternal mortality. The pathophysiology of PAS arises from the abnormal invasion of chorionic villi through the decidua basalis into the myometrium,which hinders the normal separation of the placenta from the uterine wall following delivery. The risk of PAS increases significantly among pregnant women with a history of cesarean delivery, uterine curettage,myomectomy,or other procedures that cause intrauterine scarring,particularly with an increasing number of prior cesarean deliveries, which constitutes a major risk factor for the condition in subsequent pregnancies. Consequently, the global incidence of PAS has been increasing steadily, in parallel with the rising rate of cesarean delivery worldwide.

The International Federation of Gynecology and Obstetrics (FIGO) classifies PAS into three grades: placenta accreta, in which the placenta adheres to the uterine wall without invading the myometrium; placenta increta, in which invasion extends into the myometrium; and placenta percreta,in which placental tissue penetrates through the uterine serosa and invades adjacent organs. Further,PAS is subdivided into Grades 3A, 3B, and 3C according to the extent of invasion into the uterine serosa,bladder, or adjacent pelvic structures. Severity grading directly informs treatment planning, multidisciplinary team preparation, resource allocation,and perioperative nursing care planning,making accurate antenatal classification essential to optimizing surgical outcomes.

The currently accepted standard treatment for PAS is planned cesarean hysterectomy, with the placenta left in situ and without attempting placental removal, to minimize massive postpartum hemorrhage and reduce maternal mortality. Nevertheless, this procedure is technically demanding and associated with substantial risks, including massive blood loss, injury to adjacent organs, prolonged operative time, and the need for massive blood transfusion. Therefore, successful management requires meticulous preoperative planning, adequate preparation of blood products and specialized surgical resources, and close collaboration among a multidisciplinary team consisting of obstetricians, anesthesiologists, urologists, radiologists,neonatologists,perioperative nurses,nurse anesthetists,blood bank personnel,and other healthcare professionals.Effective multidisciplinary collaboration is fundamental to improving treatment efficiency and ensuring maternal and neonatal safety.

This academic article aims to synthesize current evidence and present comprehensive perioperative nursing guidelines for pregnant women with PAS undergoing cesarean delivery with hysterectomy. The recommendations are developed using evidence-based practice, international clinical guidelines,and contemporary perioperative nursing knowledge to support systematic patient care across the preoperative, intraoperative,and postoperative periods. This article covers risk assessment,antenatal screening, prenatal diagnosis using ultrasonography and magnetic resonance imaging,disease classification according to the FIGO grading system, multidisciplinary treatment planning, preparation of blood and blood components, preparation of specialized surgical instruments and equipment, operating room preparedness, intraoperative surveillance for potential complications, postoperative nursing care in the post-anesthesia care unit, and safe transfer to the intensive care unit when indicated. The article also emphasizes the importance of standardized communication, accurate patient handover, and effective coordination among multidisciplinary team members to ensure continuity and quality of patient care.

The synthesis of current literature and international clinical practice guidelines demonstrates that successful management of PAS depends not only on obstetricians’ surgical expertise but also on effective multidisciplinary collaboration and coordinated perioperative care throughout the treatment process. Perioperative nurses assume key responsibilities for comprehensive risk assessment, patient preparation, resource management,verification of surgical instruments and medical supplies,blood and blood products, coordination and support of the surgical team, early detection and prevention of perioperative complications, effective communication,effective handover of critical patient information,and continuous postoperative nursing care.

However, implementation of evidence-based perioperative standards, combined with effective interdisciplinary communication, contributes significantly to reducing clinical errors, improving team preparedness, minimizing hemorrhagic complications, enhancing patient safety, and improving maternal and neonatal outcomes.Furthermore, the knowledge synthesized in this article canbe applied to developing standardized perioperative nursing protocols,enhancing perioperative nursing competency, strengthening multidisciplinary team preparedness, and improving healthcare service systems. These findings also support the development of evidence-based clinical practice guidelines and contribute to continuous quality improvement in perioperative nursing practice.

In conclusion,optimal management of pregnant women with PAS requires comprehensive multidisciplinary collaboration and systematic perioperative nursing care throughout the preoperative,intraoperative, and postoperative phases. Accurate risk assessment, meticulous preparation of the multidisciplinary team,blood and blood products,surgical resources,and specialized equipment, together with effective communication and the application of evidence-based practice,are fundamental components of high-quality perioperative care. These strategies can reduce hemorrhagic complications, decrease emergency hysterectomy and maternal mortality, improve maternal and neonatal safety,and enhance the quality of obstetric perioperative nursing care in accordance with international professional standards.The implementation of standardized perioperative nursing guidelines based on current evidence may further promote patient safety, improve the quality of healthcare delivery, and support sustainable development of obstetric nursing practice in tertiary healthcare settings.

Keyword: Caesarean hysterectomy,Perioperative nursing care,Placenta accreta spectrum

Author Contributions:
CD: Conceptualization, Design, Writing and revising the manuscript
PP: Conceptualization, Design, writing, revising, editing the manuscript, Corresponding with the
editor-in-chief
RP: Conceptualization, Design, Analysis, Writing, editing and revising the manuscript