How would you anesthetize the patient with placenta previa for cesarean section?

How would you anesthetize the patient with placenta previa for cesarean section?

As with a placental abruption, both the fetal and maternal condition must be evaluated. Most women with a placenta previa have an uneventful prenatal course. As the placenta covers the cervical os, cesarean delivery will be needed. In the absence of maternal hemorrhage, a regional anesthetic, spinal or epidural, may be performed in the usual fashion. Adequate intravenous access should be obtained prior to placement of the spinal anesthetic and the patient should have crossmatched blood available should unexpected hemorrhage occur. The anesthesia team must also be pre-pared to convert to general anesthesia should significant hemorrhage and maternal hemodynamic instability develop.

In the presence of significant hemorrhage, regional anesthesia is contraindicated and a general anesthetic should be performed. Adequate intravenous access should be obtained prior to induction and appropriate monitoring (e.g., arterial line) should be placed. Induction of anesthe-sia would follow the same guidelines as for a placental abruption.