Caesarean Section for Placenta Previa: A Retrospective Cohort Study of Anaesthesia Techniques

OBJECTIVE: Placenta previa is associated with maternal and neonatal morbidity and mortality. This study aims to add to the limited literature from the developing world on the association of different anaesthetic techniques with blood loss, the need for blood transfusion, and maternal/neonatal outcomes among women undergoing caesarean section with placenta previa. METHODS: This retrospective study was conducted at Aga University Hospital, Karachi, Pakistan. The patient population included parturients undergoing caesarean section for placenta previa from January 1, 2006, through December 31, 2019. RESULTS: Out of 276 consecutive cases of placenta previa progressing to caesarean section during the study period, 36.24% were performed under regional anaesthesia and 63.76% under general anaesthesia. When compared to general anaesthesia, significantly less regional anaesthesia was used for emergency caesarean section (26% vs. 38.6%, P = .033) and for grade IV placenta previa (50% vs. 68.8%, P = .013). Blood loss was found to be significantly low with regional anaesthesia (P = .005) and posterior placenta (P = .042), while it was found to be high in grade IV placenta previa (P = .024). The odds of requiring blood transfusion were low in regional anaesthesia (odds ratio = 0.122; 95% CI = 0.041-0.36, P = .0005) and posterior placenta (odds ratio = 0.402; 95% CI = 0.201-0.804, P = .010), while they were high in grade IV placenta previa (odds ratio: 4.13; 95% CI = 0.90-19.80, P = .0681). The rate of neonatal deaths and intensive care admission was significantly lower in regional anaesthesia than in general anaesthesia (7% vs. 3% and 9% vs. 3%). The maternal mortality was zero; however, intensive care admission was less in regional anaesthesia compared to general anaesthesia (<1% vs. 4%). CONCLUSION: Our data demonstrated less blood loss, need for blood transfusion, and better maternal and neonatal outcomes with regional anaesthesia for caesarean section in women with placenta previa.