We retrospectively reviewed all women with
placenta previa who underwent cesarean delivery during the period January 1, 1976-December 31, 1997 at Northwestern Memorial Hospital.
RESULTS: Of 93,384 deliveries,
placenta previa was found in 514 women. Identifiable trends with time included an increasing incidence of
placenta previa (r = 0.54, P <.01); cesarean
hysterectomy (r = 0.54, P <.01);
placenta accreta (r = 0.45, P <.03); and
regional anesthesia (r = 0.84, P <.0001). The mean gestational age at delivery was 35.3 +/- 3.4 weeks and did not change with time.
General anesthesia was used for delivery in 380 women and
regional anesthesia was used for 134 women. Prior cesarean delivery and
general anesthesia were independent predictors of the need for
blood transfusion, but only prior cesarean delivery was a predictor of the need for
hysterectomy.
General anesthesia increased the estimated blood loss, was associated with a lower postoperative
hemoglobin concentration, and increased the need for
blood transfusion. Elective and emergent deliveries did not differ in estimated blood loss, in postoperative
hemoglobin concentrations, or in the incidence of intraoperative and
anesthesia complications. Regional and
general anesthesia did not differ in the incidence of intraoperative and
anesthesia complications.
CONCLUSIONS: