Effects of anesthesia management on maternal and neonatal prognosis in patients with different types of placenta implantation

Abstract

Objective To investigate the effects of anesthesia management on maternal and neonatal prognosis in patients complicated with different types of placenta implantation. Methods A retrospective case review of the patients with placenta implantation from January 2009 to May 2017 at the department of Obstetrics in Peking University First Hospital was conducted. Patients with either natural or artificial abortion were excluded, and a total of 82 cases were enrolled into this study. According to the degree of placenta implantation, the cases were divided into 3 groups: accreta group(groupA, n=41), increta group(group I, n=20), and percreta group(group P, n=21). We analyzed the anesthesia management, and maternal and neonatal prognosis. Results Anesthetic paradigms among three groups were significantly different(P<0.05). In the accreta group, 34 cases(82.9%) underwent spinal anesthesia, 6 cases(14.6%) underwent general anesthesia, and only 1 case(2.4%) was eventually switched to general anesthesia from initial spinal anesthesia (mixed anesthesia) during the operation. In the increta group, spinal, general, and mixed anesthesia were respectively performed in 11 (55.0%), 6 cases(30.0%), and 3(15.0%) cases, in the percreta group, 2(9.5%), 12(57.1%), and 7(33.3%) cases underwent spinal, general, and mixed anesthesia, correspondingly. Patients with greater degree of placental implantation bled more and had higher rates of hysterectomy, and their neonates exhibited lower Apgar score 1 min after birth. Conclusions Spinal anesthesia can be used as the first choice of cesarean section complicated with placenta accrete, while general anesthesia should be considered in placenta percreta, especially those carrying abdominal aortic balloon catheters. Key words: Placenta implantation; Cesarean section; Anesthesia