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Anesthesia and peripartum management of parturients with suspected accreta: neuraxial versus general anesthesia.
Abstract Number: T-52
Abstract Type: Original Research
Introduction: Concurrent to the rise in cesarean delivery rate, placenta accreta (PA) has become more prevalent. Anesthesia management of PA has been described in small case series (1; it is still unclear what anesthesia is preferable for these cases
Methods: We conducted a 5-year retrospective review in two tertiary medical centers with large annual delivery volumes. PA cases were identified through the hospital database and each chart was then reviewed individually.
Results: We identified 79 suspected PA cases from June 2010-2015; from onset. 35 women underwent general anesthesia (GA) and 44 underwent neuraxial anesthesia (NA) Demographic data is presented in Table. Women who underwent general anesthesia initially had higher gravidity, higher parity and had lower gestational week. Fifteen women in the initial NA group required conversion to GA (34.1%). There were no airway complications during conversion to GA. Intraoperatively women in GA group were more likely to have arrived with emergency cesarean section and with a central placenta previa . Women in the GA group had a higher estimated blood loss, required more invasive monitoring and needed more bladder repair and peripartum hysterectomy. This was in spite of the fact that there was no significant difference in actual accretas found intraoperatively. Babies in the GA group also had a significantly lower 1 minute and 5 minute Apgar. Postoperatively more women in the GA group required blood products but there was no difference in intensive care time and hospitalization time. Using a logistic regression model predicting which women were anesthetized with GA only emergency CS (p<0.001, OR 8.4) and central placenta previa (p=0.03, OR 3.57) were determinants.
Conclusion: In the women with suspected accreta who a priori were selected for NA the rate of conversion to GA was high as 34.1% but there were no significant adverse outcome reported.