Anaesthesia management and perioperative clinical outcomes in caesarean section patients with placental pathology: a retrospective cohort study.

BACKGROUND

Placental pathologies, particularly placenta accreta spectrum (PAS) disorders and placenta previa, are major causes of maternal morbidity and mortality, largely due to the high risk of massive obstetric hemorrhage. Anesthetic management is crucial in cesarean deliveries involving these conditions, yet limited data exist regarding how anesthesia type influences perioperative outcomes.

METHODS

This retrospective cohort study evaluated 70 pregnant women who underwent cesarean section for placenta previa or PAS disorders between June 2024 and April 2025. Patients were categorized into general anesthesia (GA) and regional anesthesia (RA) groups. Clinical, surgical, anesthetic, and neonatal data were collected and compared between groups. Inverse probability of treatment weighting (IPTW) based on the propensity score was applied to minimize baseline confounding, followed by weighted regression analyses to estimate adjusted associations.

RESULTS

GA was used in 65.7% of cases, often in patients with placenta percreta and those requiring radical hysterectomy. In unadjusted analyses, GA was associated with higher estimated blood loss (1000 mL vs. 715 mL, p = 0.047), higher transfusion needs (87.0% vs. 54.2%, p = 0.004), increased maternal ICU admission (76.1% vs. 33.3%, p = 0.001), longer ICU (2 vs. 0 days, p = 0.002) and hospital stays (6 vs. 4 days, p = 0.008), and lower neonatal APGAR scores at 1 and 5 min (p = 0.008 and p = 0.009, respectively). After adjustment using IPTW, GA remained significantly associated with a higher likelihood of maternal ICU admission and longer ICU length of stay. Associations between anesthesia type and transfusion requirement, neonatal ICU admission, hospital length of stay, postoperative complications, and maternal mortality were attenuated and did not reach statistical significance after weighting.

CONCLUSION

In this retrospective cohort of cesarean deliveries complicated by placenta previa or PAS disorders, RA was associated with more favorable unadjusted maternal and neonatal outcomes. After accounting for baseline differences using IPTW, GA remained associated with increased maternal ICU utilization, reflecting its predominant use in clinically more complex and higher-risk cases.

TRIAL REGISTRATION: Not applicable.