SLIDE 7 Morbidly Adherent Placenta (MAPS) Patient Checklist
Team huddle
(ideally to be completed day before surgery)
Pre-Op
(to be completed in OR, prior to induction of anesthesia)
Post-Op
(to be completed immediately post-op, before leaving OR)
(Apply patient label) Date/time of surgery: ________________ Location: ❑ L&D ❑ Main OR #_________ GA at time of surgery: ________________
Diagnosis: ❑Accreta ❑ Increta ❑ Percreta Concern for involved organs/areas?
____________________________________
Level of concern: ❑Low ❑Medium ❑High
Personnel Primary surgeon: _____________________ Gyn Onc surgeon: _____________________ Back Up ❑ Scrubbed In ❑ Contact number: ___________________ Anesthesiologist: _____________________ Radiologist: __________________________ Interventional Rad:_____________________ Anesthesia Plan Type of anesthesia: ___________________ IV access/lines: _______________________ Special equipment needed? ❑ Belmont? Other:____________________________ Blood products (# of units to be prepared) PRBC: ____ FFP: _____ Plt: ______ Cryo: ____ Surgical plan Patient positioning: ❑ Lithotomy ❑ Supine Skin incision: ❑ Pfannenstiel ❑ Vertical Placenta plan: ❑ Remove ❑ Leave in place Uterus: Planned C hyst? ❑ Yes ❑ No Tubal if no hys? ❑Yes ❑No ❑ N/A Special equipment needed? ❑No ❑Yes:___________________________________ ❑ 3-way foley ❑ hyst tray ❑ cysto ❑ stents ❑ Other:________________________________ Nursing/OR Staff Main OR staff notified? ❑ Yes Planned scrub tech: ❑ L&D ❑ Main OR Ancillary services Cell saver notified? ❑ Yes Urology aware? ❑ Yes Contact: _____________________________ Vascular aware? ❑ Yes Contact: _____________________________ ICU aware? ❑ ICN aware? ❑ Yes Patient Healthcare proxy: ________________________ Contact: _____________________________ Patient aware of all plans: ❑ Yes Most recent Hct _______Date: _________ Blood products in OR? ❑Yes ❑N/A ICN Set Up/Ready? ❑Yes ❑N/A Disposition: ❑ ICU ❑ L&D ❑ Ante ❑ Postpartum Complications? ❑ Yes ________________ I&O/Products received: EBL: ________ UOP: ________ IVF: ______ PRBC: ________ FFP: _______ Cryo: _____ DO NOT REMOVE FROM CHART (Apply patient label)
Pathology Requisition
Specimen Dissection Instructions (directed by radiologist): ❑ Axial Plane ❑ Sagittal Plane Also note: ❑ If portion of urinary bladder wall resected en bloc w/ uterus & ❑ if uterine serosa intact upon entering the abdomen, prior to any surgical manipulation
Principles of MAPS
Although ultrasound evaluation is important, the absence of ultrasound findings does not preclude a diagnosis of PAS; thus, clinical risk factors remain equally important as predictors of PAS by ultrasound findings.
- SMFM. Placenta accreta. Am J Obstet Gynecol 2010.
