General anesthesia increases risk for hemorrhage after cesarean section
MedWire News: Women who undergo cesarean section (CS) with general anesthesia are significantly more likely to experience postpartum hemorrhage than those who undergo CS with epidural anesthesia, an analysis suggests.
This finding supports previously proposed methods of anesthetic management in obstetric hemorrhage, and provides evidence for the use of regional anesthesia in high-risk patients during CS, report Chuen-Chau Chang (Taipei Medical University, Taiwan) and co-authors.
They linked data from the Taiwan National Health Insurance Research Dataset with the national birth certificate registry to identify 67,328 women who had a live singleton birth by CS during the year 2005. Of these, 2433 received treatment with general anesthesia and 64,895 received treatment with spinal or epidural anesthesia.
Chang et al found that mothers who received general anesthesia were significantly more likely to be older than those who received spinal/epidural anesthesia, at a mean age of 30.7 years versus 29.9 years, respectively.
Mothers who received general anesthesia were also significantly more likely to experience complications such as pregnancy-induced hypertension, placental abruption, myoma, placenta accreta, emergent CS, and more likely to have experienced previous myectomy than mothers who received spinal/epidural anesthesia.
However, they were significantly less likely to experience an overdistended uterus, prolonged labor, and have had a previous CS than mothers who received spinal/epidural anesthesia.
In addition, mothers receiving general anesthesia were significantly more likely to have preterm births and low-birthweight infants than those receiving spinal/epidural anesthesia.
Analysis adjusted for mother's age, parity, and pregnancy complications revealed that mothers who received general anesthesia were a significant 8.15 times more likely to experience postpartum hemorrhage than those who received spinal/epidural anesthesia.
The authors suggest that potential mechanisms behind the effect of general anesthesia on postpartum hemorrhage could include its suppressive effects on uterine contraction, as well as on platelet function and hemostasis.
They conclude: "Our study… implies that decisions to use general anesthesia should be reconsidered when anesthetic plans are being formulated for hemorrhage-prone patients with CS."
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By Piriya Mahendra