Spinal Versus General Anesthesia in Pregnancies With Placenta Accreta Spectrum: A Retrospective Comparative Study (SAGA-PAS)

Comparison of Spinal and General Anesthesia on Maternal and Neonatal Outcomes in Pregnancies With Placenta Accreta Spectrum: A Retrospective Study

Placenta accreta spectrum (PAS) is a serious pregnancy complication in which the placenta grows abnormally into the uterine wall. This condition is associated with a high risk of severe bleeding, need for blood transfusion, hysterectomy, and maternal complications during cesarean delivery.

This study aims to compare spinal anesthesia and general anesthesia in pregnant women diagnosed with placenta accreta spectrum who underwent cesarean delivery. The researchers reviewed existing medical records to evaluate differences in maternal and neonatal outcomes between the two anesthesia approaches.

The primary outcomes include changes in hemoglobin levels before and after surgery, the need for uterotonic medications during and after the operation, and newborn Apgar scores. Because this is a retrospective observational study, no new treatments were given, and all data were collected from routine clinical care records.

The findings are expected to help guide anesthetic decision-making in PAS cases, improve maternal and neonatal safety, and contribute to the international scientific literature on this topic.

Study Overview

• Status: Not yet recruiting
• Conditions: Placenta Accreta Spectrum
• Intervention / Treatment: Procedure: spinal anesthesia; Procedure: General Anesthesia

Detailed Description

This is a single-center, retrospective observational study conducted in pregnant patients diagnosed with placenta accreta spectrum (PAS) who underwent cesarean delivery at Gaziantep City Hospital. Medical records were reviewed to identify eligible cases between the predefined study period based on imaging findings, intraoperative diagnosis, and/or histopathological confirmation of PAS.

Patients were categorized according to the type of anesthesia received during cesarean delivery: spinal anesthesia or general anesthesia. The choice of anesthetic technique was based on routine clinical practice, multidisciplinary team decision, and individual patient characteristics, rather than random assignment. No additional interventions were introduced for research purposes.

Data were extracted from electronic medical records, anesthesia charts, obstetric files, and neonatal records. Collected variables included demographic characteristics, obstetric history, imaging findings suggestive of PAS, intraoperative management strategies, estimated blood loss, transfusion requirements, use of uterotonic agents, and perioperative hemodynamic parameters. Neonatal data included gestational age at delivery, birth weight, Apgar scores at 1 and 5 minutes, need for resuscitation, and admission to neonatal intensive care.

The primary analytic focus was the comparison of perioperative hemoglobin change between the spinal and general anesthesia groups. Secondary analyses evaluated differences in intraoperative and postoperative uterotonic requirements, transfusion needs, surgical complications, length of hospital stay, and neonatal outcomes.

Statistical analyses were performed using appropriate parametric or non-parametric tests depending on data distribution. Potential confounding factors such as placenta previa status, prior cesarean history, and PAS severity were considered in subgroup analyses.

Ethics approval was obtained from the Gaziantep City Hospital Clinical Research Ethics Committee prior to data collection, and patient confidentiality was maintained in accordance with national regulations and the Declaration of Helsinki.

• Study Type: Observational
• Enrollment (Estimated): 50

Contacts and Locations

• Study Contact: Name: Recep Karakaşoğlu, MD; Phone Number: +905364668718; Email: erecep_1992@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of pregnant women diagnosed with placenta accreta spectrum (PAS) who underwent elective cesarean delivery at Gaziantep City Hospital. Participants were identified retrospectively from hospital medical records and anesthesia charts. Only patients with singleton pregnancies and complete perioperative and neonatal data were included in the analysis. The population reflects routine clinical practice in the management of PAS at a tertiary care center.

Description

Inclusion Criteria:

• Pregnant patients diagnosed with placenta accreta spectrum (PAS), Undergoing elective cesarean delivery, Receiving either spinal anesthesia or general anesthesia during cesarean section, Singleton pregnancy, Availability of complete medical and anesthesia records related to surgery and perioperative management

Exclusion Criteria:

Patients without a diagnosis of PAS, Emergency (non-elective) cesarean deliveries, Use of anesthesia techniques other than spinal or general anesthesia, Multiple pregnancy (twins or more) ,Incomplete or missing medical/anesthesia records, Missing key perioperative or neonatal outcome data

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Spinal Anesthesia; This cohort includes pregnant patients diagnosed with placenta accreta spectrum who underwent cesarean delivery under spinal anesthesia as part of routine clinical care. The anesthetic technique was selected by the multidisciplinary clinical team based on standard institutional practice and individual patient characteristics. No experimental intervention was applied for research purposes.	Procedure: spinal anesthesia; Spinal anesthesia administered for cesarean delivery as part of routine clinical care in pregnant patients with placenta accreta spectrum. The technique was chosen by the clinical team based on standard institutional practice and patient condition, not for research assignment.
General Anesthesia; This cohort includes pregnant patients diagnosed with placenta accreta spectrum who underwent cesarean delivery under general anesthesia as part of routine clinical care. The anesthetic technique was selected by the multidisciplinary clinical team based on standard institutional practice and individual patient characteristics. No experimental intervention was applied for research purposes.	Procedure: General Anesthesia; General anesthesia was administered for cesarean delivery in pregnant patients with placenta accreta spectrum as part of routine clinical care. The anesthetic technique, including airway management, induction agents, and maintenance strategy, was selected by the attending anesthesia team according to institutional standards and the patient's clinical condition. The intervention was not assigned for research purposes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of Hospital Stay to Discharge	Total duration of maternal hospitalization calculated from the time of cesarean delivery until official hospital discharge.	Postoperative day of hospital discharge, assessed up to 30 days after cesarean delivery.
Perioperative Hemoglobin Change	The difference between preoperative hemoglobin level and postoperative hemoglobin level measured within the first 48 hours after cesarean delivery in patients with placenta accreta spectrum.	From preoperative assessment to 48 hours after cesarean delivery
Neonatal Apgar Score at 1 and 5 Minutes	Neonatal Apgar scores assessed at 1 and 5 minutes after birth in infants delivered by cesarean section in pregnancies with placenta accreta spectrum.	At 1 minute and 5 minutes after birth

Collaborators and Investigators

• Sponsor: Gaziantep City Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Actual): February 1, 2026
• Study Completion (Estimated): March 30, 2026

Study Registration Dates

• First Submitted: February 3, 2026
• First Submitted That Met QC Criteria: February 11, 2026
• First Posted (Actual): February 12, 2026

Study Record Updates

• Last Update Posted (Actual): February 12, 2026
• Last Update Submitted That Met QC Criteria: February 11, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: general anesthesia; spinal anesthesia; PAS; Placenta accreta spectrum
• Additional Relevant MeSH Terms: Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Obstetric Labor Complications; Pregnancy Complications; Placenta Diseases; Placenta Accreta; Anesthesia and Analgesia; Anesthesia, Conduction; Anesthesia; Anesthesia, Spinal; Anesthesia, General
• Other Study ID Numbers: GZŞH-ANES-PAS-2025

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No