Effects of different modes of anesthesia on maternal and neonatal outcomes in puerperas with placenta previa and accreta undergoing cesarean section for second birth

Objective To 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. Methods The 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. Results A 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). Conclusion Compared 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