Key result
In pregnant women with placenta previa and suspected placenta accreta undergoing cesarean section with aortic balloon occlusion, neuraxial anesthesia was associated with significantly lower median intraoperative blood loss (500 ml vs 700 ml) compared to general anesthesia.
Why the study?
The study aimed to compare clinical outcomes of parturients with placenta previa and placenta accreta according to severity when managed with intraoperative abdominal aortic balloon occlusion during cesarean section.
Does the severity of suspected placenta accreta or the choice of anesthesia affect clinical outcomes in parturients undergoing cesarean section with intraoperative abdominal aortic balloon occlusion?
Cohort (n=57)
No
Does the severity of suspected placenta accreta or the choice of anesthesia affect clinical outcomes in parturients undergoing cesarean section with intraoperative abdominal aortic balloon occlusion?
Absolute Event Rate: 500% vs 700%
p-value: p=0.017
In parturients undergoing cesarean section with intraoperative abdominal aortic balloon occlusion for suspected placenta accreta, neuraxial anesthesia is associated with reduced blood loss and transfusion requirements compared to general anesthesia.
Severity of placental invasion may not alter blood loss with IAABO in cesarean delivery; leaves open optimal patient selection and prospective validation.
BACKGROUND: This retrospective study aimed to compare the clinical outcomes of parturients with placenta previa (PP) and placenta accreta (PA) according to their severity, when they were managed with intraoperative abdominal aortic balloon occlusion (IAABO) during cesarean section. METHODS: We retrospectively examined 57 cases of PP and suspicion for PA in which IAABO was performed during cesarean section between April 2014 and June 2016. Based on preoperative examination and clinical risk factors, patients were divided into the low suspicion PA group and the high suspicion PA group. We compared the demographic characteristics, methods of anesthesia, intra- and postoperative parameters, and maternal and neonatal outcomes. RESULTS: The two groups showed similar demographic characteristics and intraoperative outcomes. Four women underwent cesarean hysterectomy. Eight neonates were admitted to the neonatal intensive care unit and three did not survive. Neonatal Apgar scores were significantly higher in the low suspicion PA group. Eight patients experienced postoperative femoral artery thrombosis and one patient complicated hematoma in the front wall of the common femoral artery. Patients who received neuraxial anesthesia showed significantly lower intraoperative blood loss, lower intraoperative, postoperative and total blood transfusion and shorter surgery than patients who received general anesthesia. CONCLUSIONS: Our data suggested that the severity of aberrant placental position does not affect intraoperative blood loss during a cesarean section while the IAABO is performed. We propose that neuraxial anesthesia is preferred for conducting these surgeries without contraindications.
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Li et al. (2020) conducted a cohort in Placenta previa and suspicion for placenta accreta (n=57). Neuraxial anesthesia vs. General anesthesia was evaluated on Intraoperative blood loss (ml) (p=0.017). In pregnant women with placenta previa and suspected placenta accreta undergoing cesarean section with aortic balloon occlusion, neuraxial anesthesia was associated with significantly lower median intraoperative blood loss (500 ml vs 700 ml) compared to general anesthesia.
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