Background: Placenta previa is a prominent complication of pregnancy. There is increase in rate of placenta previa and accreta secondary to increase rate of cesarean section.

Objective: To compare the effects of spinal versus general anesthesia on the maternal aspects regarding morbidities and mortalities, and the neonatal outcomes.

Methods: This is randomized controlled study was carried out at Sohag University hospital. Women with major placenta previa (3rd or 4th degree) and delivered by caesarean section were included. 1st group received spinal anaesthesia while second group received general anaesthesia. both group were compared as regard operative time, estimated blood loss, amount of blood transfusion, hypotension in addition to neonatal outcomes.

Results: Eighty patients were included. Forty patients received spinal anesthesia and the same number  received general anesthesia. Operative time was statistically significant more prolonged in general anaesthesia than spinal group (104.7±23.5 versus 93.2±20.4, p value 0.021), estimated blood loss (2086±549 versus 1835±477, p value 0.032) and amount of blood transfusion (3.2±0.65  versus 2.7±0.57, p value 0.039) were increased in general anaesthesia, in contrast to hypotension that observed more frequently in spinal group (70%) compared to (42.5). Neonatal outcomes was comparable in both groups apart from Apgar score at 1 min. which was better in spinal group.

Conclusion: Spinal anesthesia is comparable to general anesthesia in  elective caesarean section of placenta previa major degree with better maternal and neonatal outcomes. However all measures should be taken to manage expected hypotension.