Mode of anesthesia for cesarean delivery with pernicious placenta previa — a retrospective study

Abstract

Objectives: Anesthesia for cesarean delivery in parturients diagnosed with pernicious placenta previa remains controversial. This study aimed to review pernicious placenta previa cases to evaluate anesthetic management strategies. Material and methods: This retrospective analysis included patients who underwent cesarean delivery (CD) for pernicious placenta previa at the Affiliated Hospital of Zunyi Medical University between December 1, 2012 and November 31, 2017. Patient demographic data, obstetric characteristics, anesthetic management, and maternal outcomes were extracted from the hospital’s computerized database. Results: In all, 61 consecutive cases of pernicious placenta previa were identified among 9512 cesarean deliveries. General anesthesia was performed on 27 of the 61 patients (44.3%). Among GA group, 16 (59.3%) had placenta accreta, 8 of whom required cesarean hysterectomy. Also, 13 of the 27 (48.1%) GA patients required transfer to the intensive care unit. The other 34 patients (55.7%) were given regional anesthesia, 9 of whom were converted to general anesthesia due to excessive bleeding and prolonged operation times. Statistical results indicated that regional anesthesia was associated with a significantly shorter operation time, less perioperative blood loss, fewer intraoperative red blood cell transfusions, and a lower incidence of complications. Conclusions: Anesthetic management is important for parturients with pernicious placenta previa. Although regional anesthesia was our preferred method for these patients, general anesthesia is safe for patients with pernicious placenta previa who experience massive blood loss and prolonged operation times.