Effect of anesthesia selection on neonatal outcomes in cesarean hysterectomies for placenta accreta spectrum (PAS)
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Jessian L. Munoz
,
Brian Hernandez
Abstract
Objectives
Optimal treatment for placenta accreta spectrum (PAS) is late-preterm cesarean hysterectomy to minimize maternal morbidity. This study aims to assess the impact of surgical planning during this gestational age on neonates as a key part of the pregnancy dyad.
Methods
A retrospective cohort analysis was performed of 115 singleton, non-anomalous pregnancies complicated by PAS at the University of Texas Health San Antonio Placenta Accreta program from 2005 to 2020. Univariate and multivariate analyses were performed to identify the individual impact of variables such as anesthesia selection, advancing gestational age and operative characteristics.
Results
With regards to neonatal intubation, on multivariate analysis, neuraxial anesthesia (OR=0.09, [95% CI 0.02, 0.37]) and advancing gestational age (OR=0.49 [95% CI 0.34, 0.71]) were independent protective factors. In addition, NICU length of stay was directly impacted by neuraxial anesthesia (IRR=0.73, [95% CI 0.55, 0.97]) and advancing gestational age (IRR=0.80 [95% CI 0.76, 0.84]), resulting in shorter NICU admissions.
Conclusions
As gestational age at delivery may not be modifiable in cases of PAS, the utilization of neuraxial anesthesia (as oppose to general anesthesia) presents a modifiable intervention which may optimize neonatal outcomes from cesarean hysterectomy.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: Institutional Review Board (IRB) approval was obtained from the University of Texas Health San Antonio and University Hospital System prior to obtaining patient information from electronic medical records.
References
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Articles in the same Issue
- Frontmatter
- Review
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- Mini Review
- The use of neurally-adjusted ventilatory assist (NAVA) for infants with congenital diaphragmatic hernia (CDH)
- Opinion Paper
- The role of specialist perinatal psychiatrists in modern medicine
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- Original Articles – Obstetrics
- Cervical ripening as an outpatient procedure in the pandemic – minimizing the inpatient days and lowering the socioeconomic costs
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- Effect of anesthesia selection on neonatal outcomes in cesarean hysterectomies for placenta accreta spectrum (PAS)
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- The effect of 150 and 80 mg doses of aspirin on preventing preterm birth in high-risk pregnant women
- Letters to the Editor
- Aspirin for the prevention of preeclampsia
- Reply to: Aspirin for the prevention of preeclampsia
- Total bile acid levels for clinically suspected intrahepatic cholestasis of pregnancy
- Reply: Neonatal lung injury with intrahepatic cholestasis of pregnancy
- Marijuana and pregnancy: just because its legal doesn’t make it safe
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Articles in the same Issue
- Frontmatter
- Review
- Obstetric hemorrhage: effective methods for addressing the menace in Sub-Saharan Africa
- Mini Review
- The use of neurally-adjusted ventilatory assist (NAVA) for infants with congenital diaphragmatic hernia (CDH)
- Opinion Paper
- The role of specialist perinatal psychiatrists in modern medicine
- Corner of Academy
- Maternal perception of fetal movements: onset and associated factors
- Original Articles – Obstetrics
- Cervical ripening as an outpatient procedure in the pandemic – minimizing the inpatient days and lowering the socioeconomic costs
- Can sonographic imaging of the fetal pancreas predict perinatal outcomes in gestational diabetes mellitus?
- Comparison of transvaginal sonographic cervical length measurement and Bishop score for predicting labour induction outcomes
- Regional differences in utilization of 17α-hydroxyprogesterone caproate (17-OHP)
- Effect of anesthesia selection on neonatal outcomes in cesarean hysterectomies for placenta accreta spectrum (PAS)
- Bile-acid levels and lung maturity test in patients with intrahepatic cholestasis of pregnancy
- Evaluation of appropriate vancomycin prescribing for the prevention of newborn group B streptococcal infections in a community hospital obstetrics service
- Effect of supplementation with 5,000 IU of vitamin D on the glycemic profile of women with gestational diabetes mellitus
- Association of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms with vitamin B12 deficiency and adverse perinatal outcomes among pregnant women of rural South India – a cross sectional longitudinal study
- Original Article – Fetus
- Fetal autopsy for the diagnosis of skeletal dysplasia and comparison with prenatal ultrasound findings over a 16-year period
- Original Articles – Neonates
- Neonatal admission rate after vaginal breech delivery
- Extremely low gestational age neonates and resuscitation: survey on perspectives of Canadian neonatologists
- The effect of 150 and 80 mg doses of aspirin on preventing preterm birth in high-risk pregnant women
- Letters to the Editor
- Aspirin for the prevention of preeclampsia
- Reply to: Aspirin for the prevention of preeclampsia
- Total bile acid levels for clinically suspected intrahepatic cholestasis of pregnancy
- Reply: Neonatal lung injury with intrahepatic cholestasis of pregnancy
- Marijuana and pregnancy: just because its legal doesn’t make it safe
- Corrigenda
- Stillbirth aftercare in a tertiary obstetric center–parents’ experiences
- Prospective risk of stillbirth according to fetal size at term
