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Perinatal outcomes comparison between neuraxial and general anesthesia in pregnant women with placenta accreta spectrum: a multicenter retrospective study

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A Letter to the Editor to this article was published on 21 May 2024

Abstract

Purpose

We investigated the impact of anesthesia mode on perinatal outcomes in patients with placenta accreta spectrum (PAS) undergoing cesarean delivery and identified factors associated with adverse perinatal events.

Methods

The multicenter retrospective analysis was conducted in patients with PAS who delivered at three medical centers. Patients were classified according to whether they received general anesthesia (GA) or neuraxial anesthesia (NA). We compared the basic clinical characteristics of patients in the pre-propensity score matching (PSM) and post-PSM cohorts and identified factors associated with a high risk of adverse maternal outcomes.

Results

This study included a total of 425 patients, with 307 (72.2%) in the GA group and 118 (27.8%) in the NA group. After PSM, 162 patients were identified for analysis. In the post-matched cohort, the NA group exhibited shorter total operation time (P = 0.030) and postoperative length of hospital stay (P = 0.037). Additionally, the NA group experienced lower intraoperative blood loss (P < 0.001) and received fewer units of transfused packed red blood cells (PRBC) (P < 0.001). Multivariate logistic regression analysis indicated that GA (P < 0.001), emergency cesarean delivery (P = 0.010), vascular lacunae within the placenta (P < 0.001), hypervascularity of uterine-placental margin (P = 0.002), hypervascularity of the cervix (P = 0.014), and balloon placement in the abdominal aorta (P < 0.001) were associated with a high risk of adverse maternal events.

Conclusion

In comparison to GA, cesarean delivery with NA in PAS patients appears to be associated with reduced intraoperative blood loss, PRBC transfusion, operating duration, and postoperative hospital stay.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua ** Road, **an, Shandong, People’s Republic of China

    Chenmian Liu, Meiling Zhang, Yarong Li, Yintao Xu, Yanan Li & Yuyan Ma

  2. Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 **gsi Road, **an, Shandong, People’s Republic of China

    Ran Chu

  3. Department of Obstetrics and Gynecology, People’s Hospital of Rizhao, Rizhao, Shandong, People’s Republic of China

    Ningning Song

  4. Department of Obstetrics and Gynecology, **an Maternity and Child Care Hospital, **an, Shandong, People’s Republic of China

    Qiuhong Yang & Yarong Li

  5. Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, Shandong, People’s Republic of China

    **ao Song

  6. Department of Anesthesiology, Qilu Hospital of Shandong University, **an, Shandong, People’s Republic of China

    Liang Li

  7. Department of Obstetrics and Gynecology, Qingdao Women and Children’s Hospital, Qingdao, Shandong, People’s Republic of China

    Meiling Zhang

Authors
  1. Chenmian Liu
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  2. Ran Chu
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  3. Ningning Song
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  6. Liang Li
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  7. Meiling Zhang
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  8. Yarong Li
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  9. Yintao Xu
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  10. Yanan Li
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  11. Yuyan Ma
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Contributions

YL contributed to collecting and analyzing the data, and preparing the manuscript; critically revised the draft and approved the final version to be published. YM and RC contributed to designing, develo**, and refining the study protocol. NS, XS, QY, LL, MZ, YL, YX helped collect data and conduct the study. YM helped design and conduct the study. All authors contributed to the manuscript amendment.

Corresponding authors

Correspondence to Yanan Li or Yuyan Ma.

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The authors have no potential conflicts to disclose.

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Liu, C., Chu, R., Song, N. et al. Perinatal outcomes comparison between neuraxial and general anesthesia in pregnant women with placenta accreta spectrum: a multicenter retrospective study. J Anesth 38, 167–178 (2024). https://doi.org/10.1007/s00540-023-03287-0

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  • DOI: https://doi.org/10.1007/s00540-023-03287-0

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