Mode of anesthesia and clinical outcomes of patients undergoing Cesarean delivery for invasive placentation: a retrospective cohort study of 50 consecutive cases

Nguyen-Lu, N.; Carvalho, José Carlos Almeida; Kingdom, John; Windrim, Rory; Allen, Lisa; Balki, Mrinalini

doi:10.1007/s12630-016-0695-x

Cited by 42 publications

(27 citation statements)

References 23 publications

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“…Bladder wall repair is a challenging procedure, often associated with massive hemorrhage, or, in the case of posterior wall involvement, ureteral injury or vesicovaginal fistula formation . Prolonged operation time and, consequently, prolonged general anesthesia may cause maternal respiratory difficulties or poor neonatal outcome . Admission to the ICU significantly increases the duration and cost of hospitalization together with acute onset of delivery.…”

Section: Discussionmentioning

confidence: 94%

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

Bourgioti

Zafeiropoulou

Fotopoulos

et al. 2018

Magnetic Resonance Imaging

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Background Placenta accreta spectrum (PAS) disorders may be associated with significant mortality and morbidity for both mother and fetus. Purpose/Hypothesis To identify MRI risk factors for poor peripartum outcome in gravid patients at risk for PAS. Study Type Prospective. Population One hundred gravid women (mean age: 34.9 years) at third trimester, with placenta previa. Field Strength/Sequence T2‐SSTSE (single‐shot turbo spin echo), T2‐TSE, T1‐TSEFS (TSE images with fat‐suppression) at 1.5T. Assessment Fifteen MRI features considered indicative of PAS were recorded by three radiologists and were tested for any association with the following adverse peripartum maternal and neonatal events: increased operation time, profound blood loss, hysterectomy, bladder repair, ICU admission, prematurity, low birthweight, and 5‐minute APGAR score <7. Statistical Tests Kappa (K) coefficients were computed as a measure of agreement between intraoperative information/histology and MRI results as well as for interobserver agreement; chi‐square and Fisher's exact tests were used to explore the association of the MRI signs with clinical complications. A score was calculated by adding all recorded MRI signs and its predictive ability was tested using receiver operating characteristic (ROC) analysis, against all complications, separately; odds ratios (ORs) for optimal cutoffs were determined with logistic regression analysis. Results There was excellent agreement (K >0.75, P < 0.001) between MRI and intraoperative findings for invasive placenta, bladder and parametrial involvement. Intraplacental T2 dark bands, myometrial disruption, uterine bulge, and hypervascularity at the utero‐placental interface or parametrium, showed significant association (P < 0.005) with poor clinical outcome for both mother and fetus. The MRI score showed significant predictive ability for each adverse maternal event (area under the curve [AUC]: 0.85–0.97, P < 0.001). The presence of ≥3 MRI signs was the cutoff point for a complicated delivery (OR: 19.08, 95% confidence interval [CI]: 6.05–60.13) and ≥6 MRI signs was the cutoff point for massive bleeding (OR: 90.93, 95% CI: 11.3–729.23), hysterectomy (OR: 72.5, 95% CI: 17.9–293.7), or extensive bladder repair (OR: 58.74, 95% CI: 7.35–469.32). The MRI score was not significant for predicting adverse neonatal events including preterm delivery (P = 0.558), low birthweight (P = 0.097), and 5‐minute Apgar score (P = 0.078). Data Conclusion Preoperative identification of specific MRI features may predict peripartum course in high‐risk patients for PAS. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:602–618.

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Section: Discussionmentioning

confidence: 94%

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

Bourgioti

Zafeiropoulou

Fotopoulos

et al. 2018

Magnetic Resonance Imaging

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“…The international literature reports an 8%–45% risk of the need to convert from regional to general anesthesia for cases of PAS disorders . Most of these occur when there is no prior suspicion of PAS disorders and the diagnosis is made intraoperatively.…”

Section: Intraoperative Considerationsmentioning

confidence: 99%

“…Of these, one randomized clinical trial was specifically designed to study women with placenta previa including accreta, and while it demonstrated that blood transfusion requirements were greater in the general anesthesia group, there was no significant difference in reported blood loss overall . No significant difference in blood loss or volume of blood transfused between regional and general anesthesia was found in a recent retrospective cohort of 50 cases of placenta accreta managed by a single Canadian CoE …”

Section: Intraoperative Considerationsmentioning

confidence: 99%

“…Neonatal outcomes, in particular neonatal respiratory complications, appear to be improved with the use of regional compared with general anesthesia, primarily through the avoidance of volatile agents crossing the placenta …”

Section: Intraoperative Considerationsmentioning

confidence: 99%

“…[38][39][40] The international literature reports an 8%-45% risk of the need to convert from regional to general anesthesia for cases of PAS disorders. [40][41][42][43] Most of these occur when there is no prior suspicion of PAS disorders and the diagnosis is made intraoperatively. The highest rates of conversion appear to occur in low-income countries, which also have higher rates of reported blood loss; therefore, general anesthesia may be the initial method of choice in this context.…”

Section: Anesthesiamentioning

confidence: 99%

See 2 more Smart Citations

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

Allen

Jauniaux

Hobson

et al. 2018

Intl J Gynecology & Obste

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289

282

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Anesthesia and postpartum pain management for placenta accreta spectrum: The healthcare provider perspective

Bartels,

Walsh,

Nieto‐Calvache

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo explore the management and experiences of healthcare providers around anesthetic care in placenta accreta spectrum (PAS).MethodsThis descriptive survey study was carried out over a 6‐week period between January and March 2023. Healthcare providers, both anesthesiologists and those involved in operative care for women with PAS, were invited to participate. Questions invited both quantitative and qualitative responses. Qualitative responses were analyzed using content analysis.ResultsIn all, 171 healthcare providers responded to the survey, the majority of whom were working in tertiary PAS referral centers (153; 89%) and 116 (70%) had more than 10 years of clinical experience. There was variation in the preferred primary mode of anesthesia for PAS cases; 69 (42%) used neuraxial only, but 58 (35%) used a combined approach of neuraxial and general anesthesia, with only 12 (8%) preferring general anesthesia. Ninety‐nine (61%) were offering a routine antenatal anesthesia consultation. Content analysis of qualitative data identified three main themes, which were “variation in approach to primary mode of anesthesia”, “perspectives of patient preferences”, and “importance of multidisciplinary team care”. These findings led to the development of a decision aid provided as part of this paper, which may assist clinicians in counseling women on their options for care to come to an informed decision.ConclusionsApproach to anesthesia for PAS varied between healthcare providers. The final decision for anesthesia should take into consideration the clinical care needs as well as the preferences of the patient.

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Mode of anesthesia and clinical outcomes of patients undergoing Cesarean delivery for invasive placentation: a retrospective cohort study of 50 consecutive cases

Cited by 42 publications

References 23 publications

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

Anesthesia and postpartum pain management for placenta accreta spectrum: The healthcare provider perspective

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