The anaesthetic management of Caesarean section for placenta praevia: a questionnaire survey

Abstract

SummaryThe purpose of this study was to determine current UK anaesthetic practice regarding the use of regional anaesthesia in the management of patients with placenta praevia presenting for Caesarean section. We asked the members of the Obstetric Anaesthetists Association to complete a postal questionnaire in which a range of clinical situations involving varying degrees of placenta praevia were presented. In each case respondents were asked whether they would be willing to use regional anaesthesia. A wide variety of clinical practice was demonstrated. Anaesthetists with two or more obstetric sessions were more willing to use regional anaesthesia for Caesarean section in the presence of placenta praevia in both elective and emergency situations associated with haemorrhage.

Brief communication (Original). Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases

“…Therefore, the present study showed that regional anesthesia was the anesthetic technique of choice for 87.6% of parturients. Most anesthesiologists prefer providing regional anesthesia for cesarean delivery for placenta previa, whereas others prefer general anesthesia in all circumstances [4,8,9]. In a retrospective review of 147 cases of placenta previa, only a quarter of cases received regional anesthesia.…”

“…The best anesthesia for cesarean delivery remains controversial. General anesthesia is believed to be preferable for this group of patients [4]. There is also evidence that a majority of anesthesiologists consider using regional anesthesia for placenta previa [4][5][6].…”

Diagnosis and management of placenta previa

“…[40] Two retrospective studies conclude that regional anesthesia is safe, [41,42] and one small randomized trial suggests that epidural anesthesia is superior to general anesthesia with regard to maternal hemodynamics. [43] When prolonged surgery is anticipated in women with prenatally diagnosed placenta accreta, general anesthesia may be preferable, and regional analgesia could be converted to general anesthesia if undiagnosed accreta is encountered [41].…”

Contraindications to regional anaesthesia in obstetrics: a survey of German practice

“…A previous UK survey also revealed a wide variety of clinical practice, demonstrating that there was no consensus view. 35 Furthermore, familiarity with technique in different clinical situations proved to be of relevance, with a greater willingness to use regional anaesthesia among anaesthetists with more frequent obstetric commitments. 35 …”

“…34,35 Anaesthetic technique for delivery should be chosen depending on bleeding status and haemodynamic stability. In the absence of hypovolaemia, continuous bleeding and coagulopathy, a regional technique may be considered safe.…”