Anesthesia management of complete versus incomplete placenta previa: a retrospective cohort study.
OBJECTIVE
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
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.
a Department of Anesthesia , Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel.
Sharon
S
Orbach-Zinger
b Department of Anesthesia , Hadassah Hebrew University Medical Center , Jerusalem , Israel.
Carolyn F
CF
Weiniger
c Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel.
Amir
A
Aviram
a Department of Anesthesia , Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel.
Alexander
A
Balla
a Department of Anesthesia , Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel.
Shai
S
Fein
a Department of Anesthesia , Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel.
Leonid A
LA
Eidelman
d Department of Anesthesia , Shaare Zedek Medical Center , Jerusalem , Israel.
Alexander
A
Ioscovich
D000328:Adult; D000768:Anesthesia, General / Q000706:statistics & numerical data; D000773:Anesthesia, Obstetrical / Q000379:methods*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D010921:Placenta Accreta / Q000175:diagnosis; D010923:Placenta Previa / Q000145:classification* / Q000601:surgery / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies
Placenta previa; accreta; anesthesia and hemorrhage