Anesthetic management in cesarean delivery of women with placenta previa: a retrospective cohort study

Abstract

Background 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. Methods A 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. Results We 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. Conclusions Our data demonstrated that neuraxial anesthesia is associated with better maternal and neonatal outcomes during cesarean delivery in women with placenta previa.

Prevalence of placenta previa among deliveries: An update systematic review and meta-analysis after the introduction of the two-child policy in Mainland China

“…As in our previous review [ 4 ], we included observational studies (cross-sectional, cohort studies, and case-control) on placenta previa among pregnant women meeting the clinical diagnostic criteria [ 26 , 27 ] conducted in mainland China, providing they reported the prevalence or incidence of placenta previa. We excluded meeting abstracts; case reports and case series; poster presentations; and articles we could not access or that had incomplete data.…”

Blood Type and Outcomes in Pregnant Women with Placenta Previa

“…Data for the study was obtained from a retrospective cohort study of women with placenta previa at our hospital from January 2014 to June 2019. Approximately 13000 babies are born annually in this university-based tertiary medical center [ 24 , 25 ]. All participants with placenta previa who had blood type and delivery information were included.…”

Maternal and Perinatal Outcomes in Placenta Previa: A Comprehensive Review of Evidence

“…For instance, a study revealed a neonatal mortality rate of 10.7 per 1,000 births in previa cases, contrasting with 2.5 per 1,000 in other pregnancies (relative risk: 4.3; 95% confidence interval: 4.0, 4.8) [ 26 , 27 ]. Additionally, perinatal mortality rates are elevated in placenta previa, with one study reporting a rate of 81 per 1,000 births [ 3 ]. The heightened risk of neonatal morbidity and mortality stems from various factors, including preterm birth, low birth weight, birth asphyxia, and neonatal sepsis [ 28 ].…”

“…Maternal and perinatal outcomes in placenta previa are of paramount importance due to the potential for significant morbidity and mortality for both the mother and the fetus. Maternal complications may include severe hemorrhage, placenta accreta spectrum (PAS) disorders, and the need for emergency cesarean section, which can lead to adverse outcomes such as hysterectomy or even maternal death [ 3 ]. Similarly, perinatal complications such as preterm birth, intrauterine growth restriction (IUGR), and neonatal morbidity and mortality are common in pregnancies complicated by placenta previa, highlighting the critical need for effective management strategies [ 4 ].…”