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The anesthetic management of central versus marginal placenta previa
Abstract Number: T-51
Abstract Type: Original Research
Introduction: According to an Israeli survey of abnormal placentation (1), spinal anesthesia is the preferred anesthesia mode for uncomplicated placenta previa (PP), whereas general anesthesia is preferred for PP with suspected accreta. Sparse data are available regarding anesthetic management and outcome of central versus marginal PP.
Methods: We conducted a 5-year retrospective study in two tertiary Israeli medical centers. We identified PP cases via an electronic medical record in the Labor and Delivery, and manually reviewed each chart to identify maternal characteristics and anesthesia and obstetric outcomes. Outcomes for central versus marginal PP were compared using appropriate tests for continuous variables with and without normal distribution, and chi-square or Fisher's exact for categorical variables. Statistical significance was considered for p-value<0.05.
We identified 452 cases of PP: 134 central and 318 marginal. Women with central PP had a significantly higher gravidity, parity number of prior cesarean delivery and prior abortions than marginal PP (p=0.011, p=0.013,p=0.002 respectively).
There was no difference between groups in preoperative ultrasound suspicion of accreta. Marginal PP presented more commonly with bleeding and required an emergency cesarean delivery, Table. General anesthesia was more commonly used for central PP. and central PP had a significantly longer surgical duration, required significantly more packed cells and blood products, and used invasive monitoring more frequently. Central PP required more frequent intraoperative conversion to general anesthesia, and had a higher frequency of peripartum hysterectomy. Women with central PP required more mechanical ventilation and intensive care admission and had longer duration of hospitalization. These differences were similar frequency of intraoperative placenta accreta for central versus marginal PP.
Conclusions: There was a significant difference in intraoperative blood loss, use of blood products, and need for invasive monitoring in central versus marginal PP in spite of the fact that the accreta rates did not differ. We believe that this information may help anesthesiologists preoperatively decide on anesthesia regimen.
(1)Ioscovich A et al. Acta Anaesthesiol Scand 2015