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

Abstract

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.

Keywords:

• Placenta previa
• accreta
• anesthesia and hemorrhage

Acknowledgments

Technical support: Atara Davis.

Ethics approval

• Institutional Review Board (IRB) names: 1. Rabin medical center Helsinki committee. 2. Shaare Zedek Med Ctr IRB.

• Date of Approval: 1.03/10/2014 2.06/09/2009.

• Approval Number: 1. 0364-14-RMC 2. 56/09.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

All funding for this study was departmental.