Analysis of multidisciplinary management of perioperative anesthesia for cesarean section in pregnant patients with placenta implantation
Objective To summarize anesthetic management experience for cesarean section in pregnant women with placen-ta implantation during the perioperative period.Methods A total of 92 pregnant women who were diagnosed with"cesarean section,placenta implantation,or placenta implantation in combination with placenta previa"from October 2017 to April 2022 were selected and their clinical data were analyzed.According to the degree of placental invasion,the patients were divided into three groups:adher-ent type group(group A,n=19),invasive type group(group B,n=43),and penetrating type group(group C,n=30).Their general mater-nal information(age,height,body weight,number of pregnancies and deliveries,and gestational age),anesthesia method,preoperative placement of abdominal aortic balloons and(or)ureteral stents,surgical duration,length of hospitalization stay,blood loss,and fibrino-gen(FIB)loss before and after surgery,intraoperative blood product transfusions(packed red blood cells,fresh frozen plasma,autolo-gous blood,FIB,prothrombin complex,and tranexamic acid),maternal outcomes[rate of hysterectomy,and intensive care unit(ICU)ad-mission rate],and neonatal outcomes(length,body weight,and Apgar score)were recorded.Results There was no statistically sig-nificant difference in the general conditions of the 3 groups of mothers.Compared with group A,group C showed decreases in gestation-al age,and increases in surgical duration,hospitalization stay,ureteral stent placement rate,transfusion volume of packed red blood cells,fresh frozen plasma,autologous blood,and tranexamic acid,and higher hysterectomy rate,and decreases in neonatal length and body weight(all P＜0.05).Groups B and C presented lower rates of spinal anesthesia,higher rates of general anesthesia,higher blood loss,higher rates of abdominal aortic balloon placement,and higher ICU admission rates than group A(all P＜0.05).Compared with group B,group C had increased surgical duration,hospitalization stay,blood loss,rates of abdominal aortic balloon and ureteral stent placement,transfusion of packed red blood cells,fresh frozen plasma,autologous blood,and tranexamic acid,as well as decreased neo-natal length and body weight,and increased hysterectomy rate and ICU admission rate(all P＜0.05).There was no significant difference among the three groups in pre-and postoperative FIB loss,transfusion volume of FIB and prothrombin complex or neonatal Apgar scores(all P＞0.05).Conclusions Spinal anesthesia remains the primary choice for parturients with placenta implantation during perioper-ative period of cesarean section.No adverse reactions from autologous blood transfusion,further confirming its safety and effectiveness.Preoperative placement of an abdominal aortic balloon significantly reduces intraoperative blood loss and lowers the rate of hysterecto-my.Multidisciplinary consultation and precise perioperative management are crucial for ensuring maternal safety.
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