Anesthetic Management in Caesarean Delivery of Women With Placenta Previa

A Retrospective Cohort Study

Dazhi Fan; Jiaming Rao; Dongxin Lin; Huishan Zhang; Zixing Zhou; Gengdong Chen; Pengsheng Li; Wen Wang; Ting Chen; Fengying Chen; Yuping Ye; Xiaoling Guo; Zhengping Liu

Disclosures

BMC Anesthesiol. 2021;21(247) 

In This Article

Background

Placenta previa is characterized by the abnormal implantation of placental tissue overlying the endocervical os.[1] It is associated with severe maternal and fetal morbidity and mortality.[2] The strongest risk factor for placenta previa is previous cesarean deliveries.[3] Along with the increasing rate of cesarean delivery, the incidence of placenta previa is increasing, and it is estimated be 1 in 200 pregnancies worldwide[4] and 1.24% in Chinese pregnancy women.[5]

Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa.[1] The key role of anesthetist is provision of a safe, comfortable and positive birth experience for pregnant women and an optimal operating condition for obstetricians during cesarean delivery.[6] General anesthesia is a more quickly administered procedure and is preferred in cases where speed is important.[7] However, 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] Neuraxial anesthesia can cause a substantial drop in maternal blood pressure, which may affect both mother and fetus, and may be dangerous when the woman has a bleeding complication.[10,11] 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]

Because of the possible increased blood loss in these patients, some believe that general anesthesia is preferable for cesarean delivery for placenta previa, while others believe that cesarean delivery for placenta previa can be usually safely performed using neuraxial anesthesia.[1,13] The RCOG considered that neuraxial anesthesia is safe and had a lower risk of hemorrhage than general anesthesia for cesarean delivery in women with placenta previa.[3] Due to the relatively uncommon occurrence of placenta previa, larger cohort data regarding characteristics and outcomes of placenta previa cases undergoing cesarean delivery with anesthesia mode are limited. This study aimed to describe the association between anesthetic technique (neuraxial vs. general) and blood loss and maternal intraoperative hemodynamics in patients undergoing cesarean delivery for placenta previa in a large cohort database. These findings may be beneficial for the anesthesia risk stratification, counseling, and delivery planning of women diagnosed with placenta previa.

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