The association between anesthesia method and perinatal outcomes in placental invasion anomalies

To evaluate the effects of different anesthesia procedures and surgical approaches on maternal and neonatal outcomes in cases of abnormal placental invasion (API), and to determine the factors that predict the transition from spinal anesthesia to general anesthesia.

This retrospective cohort study included 115 patients who underwent API surgery at University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey; between 2015 to 2023. Demographic, obstetric, anesthetic, surgical, and neonatal data were analyzed. Comparisons were made based on the anesthesia type (spinal, general, and spinal-to-general conversion) and depth of invasion.

Placenta percreta was detected in 67% of the cases. As the severity of invasion increased, the operative time, blood and fluid replacement, and hospital stay were significantly prolonged (p<0.05). The American Society of Anesthesiologists (ASA) score, blood product consumption, and intraoperative complication rates were significantly higher in patients undergoing general anesthesia (p<0.001). Spinal anesthesia was the first choice (91.3%), and 47.6% of the cases required intraoperative conversion to general anesthesia. ROC analysis revealed that colloid use, ASA score, and fibrinogen requirement were significant predictors. There were no statistically significant differences in neonatal outcomes between the groups.

In API cases, initiating neuraxial anesthesia, which allows for transition to general anesthesia when necessary, may improve maternal safety. Parameters such as colloid use and ASA score may guide early identification of high-risk cases. Prospective multicenter studies are required to establish standard management protocols for this high-risk group.