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Spinal anesthesia for cesarean delivery in patients with placental abruption on maternal and neonatal outcome-Is there a safety time limit?
Abstract Number: T5B-4
Abstract Type: Original Research
OBJECTIVES: Placental abruption is an obstetric emergency which may cause maternal DIC, IUFD, and neonatal asphyxia. General anesthesia is often selected in caesarean delivery because of possible coagulopathy and concern for spinal hematoma. However, it is not rare to find abruption intraoperatively in women who have received spinal anesthesia for non-reassuring fetal status. We hypothesized that spinal anesthesia can be safely provided in selected patients within certain time limit for better neonatal outcome. METHODS: We retrospectively reviewed medical and anesthesia records in patients with the antenatal diagnosis of placental abruption who underwent cesarean delivery in our hospital from January 2000 to December 2014. We reviewed maternal background, duration from diagnosis to delivery, anesthesia method, intraoperative course, maternal complication, neonatal condition and long-term outcome, and compared by anesthesia method. Duration from the diagnosis and laboratory finding coagulopathy was also reviewed. RESULTS: Among 127 cases of placental abruption during this period, following cases were excluded; vaginal delivery (1), IUFD (26), intraoperative diagnosis (22), gestation before 22 weeks (3), chronic placental abruption (1), leaving 74 cases for comparison. 54 (73.0%) women received general anesthesia (GA group), while 20 (27.0%) women received spinal anesthesia (SA group). There was no difference in gestational age (31.5 ± 4.7 vs. 32.2 ± 5.0 week), duration from diagnosis to delivery (67.5 (5 - 253) vs. 77 (23 - 165) min), postoperative ICU admission (3.7% vs. 0%), DIC (25.9% vs. 10.0%), in GA and SA group, respectively. Interval from OR arrival to delivery was shorter (20.5 (8-43) vs. 9.0 (1-27) min), and estimated blood loss in OR was larger (1158 (300 - 7010) vs. 786.5 (600 - 1680) mL) and amount of blood transfusion was less in GA group (p <0.01). Neonatal outcome was not significantly different with UA pH <7.0 and Apgar score at 5 minutes<7. Apgar score at 1 minute<7 (43.4% vs. 26.3%) and NICU admission were more frequent (92% vs. 58%) in GA group (p <0.01). First laboratory result of each patient after the onset of symptoms was reviewed with regard to the presence of coagulopathy defined as one of the followings; PT-INR≧1.5, platelet count<100K/mm3, fibrinogen level<100 mg/dl. All of the 17 samples within 2 hours of the onset were normal, but 6 samples later than 2 hours of the onset showed coagulopathy (15.6%). CONCLUSION: Our results showed that both maternal and neonatal outcomes were better in placental abruption patients who received spinal anesthesia for cesarean delivery. General anesthesia may have been chosen in more severe and emergent situations. Spinal anesthesia may be safely provided within 2 hours from the onset of symptoms in women with suspected placental abruption without IUFD when laboratory results are not available before induction of anesthesia.