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Anesthetic considerations for high order cesarean sections: a prospective cohort study
Archives of Gynecology and Obstetrics
|August 21, 2013
Summary
High order repeat cesarean sections (HOR-C/S) increase surgery duration and blood transfusion needs but do not raise anesthesia conversion rates. HOR-C/S is not an absolute contraindication for regional anesthesia if hemorrhage causes are excluded.
Area of Science:
- Obstetrics and Gynecology
- Surgical Outcomes
- Maternal Health
Background:
- Previous retrospective studies indicated low complication rates for high order repeat cesarean sections (HOR-C/S).
- This study prospectively compares complication incidence in patients undergoing four or more cesarean sections versus three or fewer.
Purpose of the Study:
- To compare the incidence of perioperative complications between high order repeat cesarean sections (HOR-C/S) and lower order cesarean sections.
- To evaluate anesthesia conversion rates, surgical duration, and blood loss in HOR-C/S.
Main Methods:
- Prospective, observational cohort study.
- Inclusion of parturients undergoing cesarean section (C/S) at a single tertiary care hospital over one year.
- Comparison of HOR-C/S (four or more C/S) with a control group (three or fewer C/S).
Main Results:
- 129 HOR-C/S cases were compared to 702 controls.
- Prolonged surgery incidence was significantly higher in the HOR-C/S group (RR = 3.6).
- Intraoperative blood transfusion incidence was also higher in the HOR-C/S group (RR = 3.4).
- Conversion from regional to general anesthesia rates were similar between groups.
Conclusions:
- Patients undergoing HOR-C/S face increased risks of prolonged surgery and requiring blood transfusions.
- Regional anesthesia remains a viable option for HOR-C/S when severe hemorrhage causes are ruled out.
- HOR-C/S is not an absolute contraindication for regional anesthesia in this patient population.
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