Blood loss in elective cesarean section: is there a difference related to the type of anesthesia? A randomized prospective study

Abstract

Original Investigation 158 IntroductionTwenty million cesarean sections (CS) are performed worldwide each year (1, 2). The CS rates have steadily increased worldwide over the past decades (3-6) Moreover, Turkey has experienced a rapid increase in the rate of CSs. According to data from the Turkish Ministry of Health and National Institute of Statistics, the CS rate per live births increased from 21.2% in 2003 to 48% in 2011. Although the safety of CSs has improved, it is still associated with greater rates of maternal morbidity and mortality than vaginal delivery (7,8). CS delivery is associated with severe maternal morbidity, including obstetric hemorrhage, hysterectomy, anemia, blood transfusion, and infection (9-11). Among these operative morbidities associated with CS, obstetric hemorrhage is the leading cause of maternal mortality worldwide. Because of both the potential maternal risks and financial concerns, the increase in the cesarean rate is a serious public health problem (12, 13). Anesthesia in pregnant women has always been a concern in obstetric surgery. Anesthesia in CS is of particular concern because it affects millions of women worldwide. Despite substantial improvements in anesthetic and surgical techniques, operative blood loss during CS is still an important medical issue (14). Therefore, this study aims to compare the effects of general and spinal anesthesia on maternal blood loss among women scheduled for elective CS. Material and MethodsThis study is a prospective randomized study. It was performed in a tertiary referral hospital between September 2013 and February 2014. The study protocol was approved by Objective: We aimed to compare the effect of general and spinal anesthesia on maternal blood loss in elective cesarean section (CS). Material and Methods:This was a prospective randomized study and included 418 healthy pregnant women with a term uncomplicated singleton pregnancy between 37 and 41 weeks of gestation. The study participants were randomly divided into two groups: the general anesthesia group and spinal anesthesia group. CSs were all performed using the same surgical technique, and within the groups, the same anesthetic procedures were used (either general or spinal). The primary outcome for this study was operative blood loss. Hemoglobin and hematocrit concentrations were compared between the two groups. Results:The preoperative hemoglobin and hematocrit levels were similar in the both groups (p=0.08 and p=0.239, respectively). Significantly lower operative blood loss was achieved using spinal anesthesia versus general anesthesia during elective CS. The differences between preoperative and postoperative blood values for both the study groups were statistically significant (p<0.001). Conclusion:This study demonstrates that spinal anesthesia is associated with a lower risk of operative blood loss than general anesthesia in low risk patients undergoing elective CS. (J Turk Ger Gynecol Assoc 2015; 16: 158-63) Keywords: Operative blood loss, cesarean section, anesthesia Receiv...

The Effect of Different Doses of Intrathecal Hyperbaric Bupivacaine Plus Sufentanil in Spinal Anesthesia for Cesarean Sections

“…Spinal anesthesia is the most common method of anesthesia for caesarean section. Administration of an appropriate dose and combination of local anesthetics could minimize the possible side effects and simultaneously improve the quality of block ( 1 , 2 ). Hyperbaric bupivacaine with proper use of adjutants has been considered as acceptable common method of spinal anesthesia in caesarian section ( 3 , 4 ).…”

Statistical analysis plan for the WOMAN-ETAPlaT study: Effect of tranexamic acid on platelet function and thrombin generation

“…In a study about the mode of anaesthesia related to PPH after caesarean deliveries, a significantly higher amount of blood loss during general anaesthesia compared to spinal anaesthesia was previously reported ( Aksoy et al, 2015 ). The reduction of blood loss in neuroaxial anaesthesia maybe was caused partly from hypotension and by fluids infused in these women ( Heesen et al , 2013 ).…”

Statistical analysis plan for the WOMAN-ETAPlaT study: Effect of tranexamic acid on platelet function and thrombin generation

“…In a study about the mode of anaesthesia related to PPH after caesarean deliveries, a significantly higher amount of blood loss during general anaesthesia compared to spinal anaesthesia was previously reported (Aksoy et al, 2015). The reduction of blood loss in neuroaxial anaesthesia maybe was caused partly from hypotension and by fluids infused in these women (Heesen et al, 2013).…”