Anesthesia management of complete versus incomplete placenta previa: a retrospective cohort study. (3rd May 2018)

• Record Type: Journal Article
• Authors: Orbach-Zinger, Sharon; Weiniger, Carolyn F.; Aviram, Amir; Balla, Alexander; Fein, Shai; Eidelman, Leonid A.; Ioscovich, Alexander
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 31:Number 9(2018)
• Page Start: 1171
• Page End: 1176
• Publication Date: 2018-05-03
• Subjects: Placenta previa -- accreta -- anesthesia and hemorrhage; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2017.1311315
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Purpose: Placenta previa (PP) is a major cause of obstetric hemorrhage. Clinical diagnosis of complete versus incomplete PP has a significant impact on the peripartum outcome. Our study objective is to examine whether distinction between PP classifications effect anesthetic management. Methods and materials: This multi-center, retrospective, cohort study was performed in two tertiary university-affiliated medical centers between the years 2005 and 2013. Electronic delivery databases were reviewed for demographic, anesthetic, obstetric hemorrhage, and postoperative outcomes for all cases. Results: Throughout the study period 452 cases of PP were documented. We found 134 women (29.6%) had a complete PP and 318 (70.4%) had incomplete PP. Our main findings were that women with complete PP intraoperatively had higher incidence of general anesthesia ( p = .017), higher mean estimated blood loss ( p < .001), increased blood components transfusions ( p < .001), and significant increase in cesarean hysterectomy rate ( p < .001) than women with incomplete PP. Additionally, complete PP was associated with more postoperative complications: higher incidence of admission to the intensive care unit (ICU) ( p < .001), more mechanical ventilation ( p = .02), a longer median postoperative care unit (PACU) ( p = .02), ICU ( p = .002), and overall length of stay in the hospital ( p < .001). Conclusions: Complete PP is associated with increased risk of hemorrhage compared with incomplete PP. Therefore distinction between classifications should be factored into anesthetic management protocols.