Caesarean section for placenta praevia: a retrospective study of anaesthetic management

A retrospective survey of anaesthesia for Caesarean section(CS) for placenta praevia was performed, covering the periodbetween January 1, 1984 and December 31, 1998. Three hundredand fifty consecutive cases of placenta praevia were identified.Overall a regional technique was used 60% of the time. Fivewomen had a placenta accreta which required Caesarean hysterectomy:one had general anaesthesia (GA) throughout and four initiallyreceived a single-shot spinal injection. Of these latter fourcases, two were converted to GA during the hysterectomy andtwo continued with spinal anaesthesia throughout. Two otherwomen (both GA), suffered postoperative thrombotic episodes(one pulmonary embolus and one cerebral thrombosis) but madefull recoveries. Control of blood pressure when using regionalanaesthesia (RA), even in the presence of considerable haemorrhage,was not a problem. Statistical regression models indicated thatRA was associated with a significantly reduced estimated bloodloss and reduced need for blood transfusion. This retrospectivesurvey finds no data to support the much quoted aphorism thatRA is contraindicated for CS in the presence of placenta praevia.