SAN DIEGO – Three of the main risk factors for severe hemorrhage following a cesarean are abnormal placenta, uterine rupture or incision extension, and labor prior to cesarean, results from a large single-center study demonstrated.
For the study, Steven Kyle Thompson, D.O., and his associates at the University of Kansas, Wichita, reviewed the medical records of 3,677 cesarean deliveries performed at Wesley Medical Center, a large hospital in Wichita affiliated with the university, from Jan. 1, 2009 through Oct. 31, 2010. Hemorrhage was defined as having at least 1,000 mL of estimated blood loss (EBL) after the procedure.
Doug Brunk/IMNG Medical Media
Dr. Steven Kyle Thompson
Hemorrhage occurred in 303 of the deliveries (8.2%), and there were no maternal or fetal deaths. The researchers observed that the median EBL was greater in cases that involved administration of misoprostol, methylergonovine, or carboprost tromethamine vs. nothing (1,400 mL vs. 1,200 mL, P less than .001), as well as with the use of a Bakri balloon, B-Lynch suture, or cesarean hysterectomy vs. nothing (3,000 mL vs. 1,200 mL, P less .001). Median EBL also was greater in cases that required blood transfusion (2,500 mL vs. 1,200 mL, P less .001) and use of an intensive care unit (2,000 mL vs. 1,200 mL, P less .001).
Dr. Thompson and his associates also observed that a hemoglobin decrease by at least 30% of the preoperative value was significantly associated with abnormal placenta (odds ratio [OR], 5.38), uterine rupture or incision extension (OR, 2.81), labor prior to cesarean (OR, 2.78), and EBL of at least 1,500 mL (OR, 2.44).
Adjusted independent risk factors that were significantly associated with a postoperative decrease in hemoglobin below 7 g/dL were abnormal placenta (OR, 5.50), delivery between 2 a.m. and 7 a.m. (OR, 4.85), preoperative hemoglobin less than 11 g/dL (OR, 4.03), labor before cesarean (OR, 2.61), and EBL of at least 1,500 mL (OR, 2.31), they reported in a poster session at the annual meeting of the American College of Obstetricians and Gynecologists.
"Plan ahead of time if you have an individual who falls into a high-risk category," Dr. Thompson, a fourth-year ob.gyn. resident at the university, advised in an interview.
The researchers are currently replicating the study for vaginal deliveries.
Dr. Thompson said that he had no relevant financial conflicts to disclose.