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


BMC Anesthesiol. 2021;21(247) 

In This Article


A total of 1234 placenta previa subjects were included in the study; 737 (59.7%) with neuraxial anesthesia and 497 (40.3%) with general anesthesia. Table 1 summarized the baseline distribution of placenta previa subjects. The neuraxial and general groups were similar in maternal age, height, weight, and BMI. Subjects with general anesthesia were delivered earlier, had more gravidities, and had a higher proportion of placenta accreta spectrum, anterior placenta, antepartum hemorrhage, emergency cesarean delivery, and history of cesarean delivery and placenta previa.

Table 2 showed the perioperative data and maternal and neonatal outcomes between the two groups. Estimated blood loss was less (558.96 ± 42.77 ml vs. 1952.51 ± 180.00 ml) and the rate of blood transfusion was lower in the neuraxial group. The preoperative hemoglobin concentration was higher in the general group. However, the postoperative hemoglobin concentration was not different between the two groups. The operating time and anesthesia-to-delivery time were shorter in the neuraxial group. For neonatal outcomes, the Apgar scores were all higher at 1-, 5-, and 10-min in the neuraxial group, and the proportion of neonatal asphyxia and admission to NICU were lower in the neuraxial group.

In the regression models, blood loss was less, and preoperative hemoglobin concentration and Apgar score were higher, and the rate of blood transfusion, neonatal asphyxia, and admission to NICU were lower in the neuraxial group. After adjusting anesthesia-to-delivery time, there was no substantial change in the results. After further adjusting for anesthesia-to-delivery time and other relevant confounding factors (gestational weeks, gravity, PAS, anterior placenta, previous cesarean delivery, previous placenta previa, antepartum hemorrhage, and emergency cesarean delivery), we found that the above results remained significantly (Table 3). After excluding PAS cases, the main results did not materially change, either (Supplement Tables 1, 2 and 3).