Obstetric Anesthesia
Effects of different modes of anesthesia on maternal and neonatal outcomes in puerperas with placenta previa and accreta undergoing cesarean section for second birth
Bao Tuvshin, Niu Lingxia, Nie Bingqing, Gui Ping, Xu Qiang, Xia Leiming, Lin Yun, Yao Shanglong
Published 2019-11-20
Cite as Chin J Anesthesiol, 2019,39(11): 1367-1370. DOI: 10.3760/cma.j.issn.0254-1416.2019.11.024
Abstract
ObjectiveTo evaluate the effects of different modes of anesthesia on maternal and neonatal outcomes in puerperas with placenta previa and accreta undergoing cesarean section for second birth.
MethodsThe trials involving puerperas with a singleton fetus, aged ≥20 yr, at ≥28 weeks of gestation, with placenta previa and accreta, undergoing caesarean section for second birth, retrospectively reviewed from January 2015 to May 2017 in our hospital, were selected.Puerperas were divided into epidural anesthesia group (group E) and general anesthesia group (group G) according to the mode of anesthesia.Maternal outcomes included incision-delivery time, operating time, postpartum hemorrhage and intraoperative hypotension, intraoperative blood loss, volume of blood transfused, volume of crystalloid solution and colloid solution infused, uterine contractions used≥2 types, implementation of surgical hemostatic measures, hysterectomy, postpartum Hb, transfer to intensive care unit after operation, and length of hospital stay.Neonatal outcomes included premature, Apgar score at 1 and 5 min after birth, transfer to pediatrics unit and perinatal death.
ResultsA total of 269 pueroeras were enrolled in the study, and among the 269 pueroeras, there were 219 cases of elective repeat cesarean section (ERCS) and 50 cases of cesarean section after vaginal birth (CAVB). Pueroeras of ERCS: Compared with G group, the emergency rate was significantly decreased, the prenatal Hb concentration was increased, the operating time and length of hospital stay were shortened, and the intraoperative blood loss, volume of blood transfused, volume of crystalloid solution and colloid solution infused, incidence of postpartum hemorrhage, implementing rate of surgical hemostatic measures, incidence of hysterectomy, postpartum Hb, and rate of transfer to intensive care unit after operation were decreased in E group (P<0.05). Pueroeras of CAVB: Compared with G group, the incidence of postpartum hemorrhage and implementing rate of surgical hemostatic measures were significantly decreased, and the rate of Apgar score≤7 at 1 and 5 min after birth and rate of transfer to pediatrics unit were decreased in E group (P<0.05).
ConclusionCompared with general anesthesia, epidural anesthesia has less effect on maternal and infant outcomes and should be preferred for this type of puerperas with placenta praevia and accreta undergoing cesarean section for second birth.
Key words:
Cesarean section; Anesthesia, general; Anesthesia, epidural; Placenta previa
Contributor Information
Bao Tuvshin
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Niu Lingxia
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Nie Bingqing
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Gui Ping
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Xu Qiang
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Xia Leiming
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Lin Yun
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Yao Shanglong
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
