Anesthesia management of complete versus incomplete placenta previa: a retrospective cohort study

作者：Orbach Zinger Sharon^*; Weiniger Carolyn F; Aviram Amir; Balla Alexander; Fein Shai; Eidelman Leonid A; Ioscovich Alexander

来源：Journal of Maternal-Fetal and Neonatal Medicine, 2018, 31(9): 1171-1176.

DOI：10.1080/14767058.2017.1311315

• Placenta previa
• accreta
• anesthesia and hemorrhage

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.

• 出版日期2018