Management of anesthesia for cesarean section in parturients with placenta previa with/without placenta accreta: a...

The aim of this retrospective study was to review placenta previa cases and determine the prognostic factors effective on morbidity and mortality and to evaluate the strategy of anesthetic management.

65 women with placenta previa scheduled for elective or emergency cesarean sections from 2004 to 2009 were examined. Patient demographic data, surgery and obstetric characteristics, anesthetic techniques, blood transfusions, the values of hemoglobin and complications were recorded.

Mostly general anesthesia was preferred in the parturients with placenta previa (86.2%, 56/65). 9 patients (13.8%), 2 of whom were converted to general anesthesia due to bleeding and prolonged surgery received regional anesthesia. 37 of 65 women (56.9%) with placenta previa had had cesarean sections previously. More than half of these patients (21/37, 56.7%) had abnormally invasive placentation and 16 of 21 cases underwent cesarean hysterectomy. The incidence of complications in women with previous cesarean section with abnormally invasive placentation was higher than in the other women (p < .0001). Three patients were transferred to the intensive care unit; 2 were intubated and mechanical ventilation was applied, and 1 died of hemorrhage.

Anesthetic management is important for parturients with placenta previa who had previous cesarean section or abnormally invasive placentation. We found that general anesthesia was our method of preference for placenta previa as we wished to avoid the risk of bleeding. However, regional anesthesia can be safe in patients lacking any abnormally invasive placentation.