Anaesthesia for caesarean delivery in patients with placenta accreta spectrum: a retrospective cohort study in two referral centres in Ireland (2017-2024).

BACKGROUND

Placenta accreta spectrum disorders represent a major anaesthetic and surgical challenge, yet there are limited published data describing anaesthetic management in Ireland. This study examined anaesthetic practices and maternal and neonatal outcomes in patients with placenta accreta spectrum undergoing caesarean delivery in two tertiary referral maternity hospitals in Ireland.

METHODS

A retrospective cohort study was conducted between 2017 and 2024, including 75 women with placenta accreta spectrum. Data collected included demographics, anaesthetic techniques, intraoperative management, and maternal and neonatal outcomes. Outcomes were compared across three groups: general anaesthesia only, combined neuraxial and general anaesthesia, and neuraxial anaesthesia only.

RESULTS

Combined neuraxial and general anaesthesia was the most common anaesthetic approach used (50.7%), with 63 patients (84%) receiving a general anaesthetic at some point during surgery. Use of general anaesthesia was employed in all non-elective cases and was associated with performance of hysterectomy (OR 6.6, 95% CI 1.34, 32.9; P = 0.02), increased blood loss (OR 1.001, 95% CI 1.00, 1.00); P = 0.043), reduced Apgar scores at 5 and 10 min (P < 0.011) and greater need for neonatal intubation (P = 0.002).

CONCLUSIONS

General anaesthesia was performed in the majority of placenta accreta spectrum cases although in many patients this was combined with neuraxial anaesthesia. General anaesthesia was associated with greater maternal blood loss and poorer neonatal outcomes, although these findings should be interpreted with caution given the performance of general anaesthesia in all non-elective cases.