Abstract
BackgroundThe incidence of placenta preiva is rising. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa. Anesthesia is important during the cesarean delivery. The aim of this study is to assess maternal and neonatal outcomes of patients with placenta previa managed with neuraxial anesthesia as compared to those who underwent general anesthesia during cesarean delivery.MethodsA retrospective cohort study was performed of all patients with placenta preiva at our large academic institution from January 1, 2014 to June 30, 2019. Patients were managed neuraxial anesthesia and general anesthesia during cesarean delivery.ResultsWe identified 1234 patients with placenta previa who underwent cesarean delivery at our institution. Neuraxial anesthesia was performed in 737 (59.7%), and general anesthesia was completed in 497 (40.3%) patients. The mean estimated blood loss at neuraxial anesthesia of 558.96 ± 42.77 ml were significantly lower than the estimated blood loss at general anesthesia of 1952.51 ± 180 ml (p < 0.001). One hundred and forty-six of 737 (19.8%) patients required blood transfusion at neuraxial anesthesia, whereas 381 out of 497 (76.7%) patients required blood transfusion at general anesthesia. The rate neonatal asphyxia and admission to NICU at neuraxial anesthesia was significantly lower than general anesthesia (2.7% vs. 19.5 and 18.2% vs. 44.1%, respectively). After adjusting confounding factors, blood loss was less, Apgar score at 1- and 5-min were higher, and the rate of blood transfusion, neonatal asphyxia, and admission to NICU were lower in the neuraxial group.ConclusionsOur data demonstrated that neuraxial anesthesia is associated with better maternal and neonatal outcomes during cesarean delivery in women with placenta previa.
Highlights
The incidence of placenta preiva is rising
This study aimed to describe the association between anesthetic technique and blood loss and maternal intraoperative hemodynamics in patients undergoing cesarean delivery for placenta previa in a large cohort database
Pregnant women who met the following inclusion criteria were included for analysis: 1) placenta preiva diagnosed by ultrasound before delivery; 2) placenta previa confirmed during delivery by obstetrician; 3) pregnant women undergoing cesarean delivery; 4) singleton gestation
Summary
The incidence of placenta preiva is rising. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa. Anesthesia is important during the cesarean delivery. The aim of this study is to assess maternal and neonatal outcomes of patients with placenta previa managed with neuraxial anesthesia as compared to those who underwent general anesthesia during cesarean delivery. Placenta previa is characterized by the abnormal implantation of placental tissue overlying the endocervical os [1]. It is associated with severe maternal and fetal. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa [1]. Some early studies identified an association between general anesthesia for cesarean delivery and increased rates of airway complications, including failed intubations, maternal aspiration and aspiration pneumonitis [8, 9]. The advantages of neuraxial anesthesia include reduction in uteroplacental drug transfer, avoidance airway instrumentation, and improvement parent-baby bonding via immediate skin to skin contact, since the mother is awake during the procedure [12]
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