Safety of subarachnoid block for elective cesarean delivery in women with major degree placenta previa

Abstract

Background: Placenta previa is a serious complication of pregnancy, often causing antepartum hemorrhage with significant fetomaternal morbidity and mortality. The ideal anesthetic technique for cesarean section is controversial because of associated complications. The study aimed at ascertaining the safety of subarachnoid block among women with major degree placenta delivered by elective cesarean section. Materials and Methods: This was a prospective analysis of 11 parturients of the American Society of Anesthesiologists Class I/II with major degree placenta previa billed for elective cesarean section, who desired and consented for spinal anesthesia over a 32‑month period. Spinal anesthesia was induced with 10 mg heavy bupivacaine plus 0.5 mg morphine sulfate after a 2‑L infusion of normal saline. The surgeon incised the uterus only after 10 IU of intravenous oxytocin was given. Data collected included pre‑ and post‑operative packed cell volume (PCV), mean arterial pressure (MAP), pulse rate, peripheral oxygen saturation, estimated blood loss (EBL), and Apgar scores. The data were analyzed using SPSS version 21 for Windows® with statistical significance set at P < 0.05. Results: The mean preoperative PCV was 33.6 ± 3.5% and pulse rate was 99.3 ± 8.5/min while MAP was 97.9 ± 9.9 mmHg. Mean EBL was 918.2 ± 499.6 ml. Apgar scores at 1 and 5 min were 8.8 ± 1.2 and 10.00, respectively. There was no statistical significance between pre‑ and post‑operative parameters: Pulse rate 95.71 ± 14.07/min (P = 0.96), MAP 95.7 ± 12.13 (P = 0.70), and PCV 30.3 ± 3.9 (P = 0.32). Ten parturients (90.9%) had spinal hypotension. There was no maternal or fetal death. Conclusion: Subarachnoid block is safe in women undergoing cesarean delivery for major degree placenta previa, but anticipation for hypotension is important.