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Anesthetic Choice for Suspected Placenta Accreta and Maternal and Neonatal Outcomes
Abstract Number: T-76
Abstract Type: Original Research
Introduction: Equipoise may exist for the ideal type of anesthesia to be chosen for surgical management of suspected placenta accreta. This study aims to determine if the type of anesthesia induced for cases of placenta accreta correlates with severe maternal hemorrhage and neonatal compromise.
Design: In this IRB approved, single-center, retrospective observational cohort study, subjects with prenatal ultrasonographic diagnosis of accreta who delivered between 2007 and 2014 were identified. Pathology reports were used to cross-reference diagnoses and to identify cases detected late in prenatal care. All cases had antenatal anesthesia consultation and multidisciplinary preoperative planning. Severe hemorrhage was defined as estimated blood loss (EBL) ≥2 liters (L) and any requirement for transfusion. Neonatal compromise was defined as a 5-minte Apgar score of ≤6. Bivariate logistic regression analysis was performed to identify and adjust for factors that may have influenced anesthesia choice, risk for higher blood loss, need for transfusion, and lower Apgar scores. Fisher’s exact test was used for categorical variables and Wilcoxon rank sum test for continuous variables. A P < 0.05 was considered significant.
Results: 51 cases were identified. Table 1 shows characteristics of women receiving neuraxial (NA) or general anesthesia (GA). The incidence of EBL ≥2L and transfusion was similar for both anesthesia groups (EBL <2L: GA = 26.1% v. NA = 73.9%; ≥2L: GA = 35.7%, NA = 64.3%, P=0.552. No transfusion: GA = 30.8%, NA = 69.2%; Transfusion: GA = 31.6%, NA = 68.4%, P>0.999). After adjusting for mode of delivery, anesthesia choice remained not significantly related to EBL or transfusion. GA was associated with lower 1-minute, but not 5-minute, Apgar scores compared to NA (1-minute Apgar ≤6: GA = 70.0% v. NA = 30.0%; >6: GA = 20.8% v. NA 79.2%, P=0.015. 5-minute Apgar ≤6: GA = 60.0% v. NA = 40.0%; >6: GA = 31.0% v. NA = 69.0%, P>0.319). Intraoperative conversion from NA to GA was not associated with increased EBL or transfusion (EBL <2L: GA conversion = 34.8% v. NA or GA = 65.2%; EBL ≥2L: GA conversion = 28.6% v. NA or GA = 71.4%, P=0.764. No transfusion: GA conversion = 23.1% v. NA or GA = 76.9%; transfusion required: GA conversion = 34.2% v. NA or GA = 65.8%, P=0.730).
Conclusions: Anesthetic choice for the surgical management of suspected placenta accreta does not appear to correlate with severe hemorrhage or neonatal compromise.