Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

Abstract

Background Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use. Methods We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group). Results Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intra-operative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group. Conclusions Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.

Choice of fluid type: physiological concepts and perioperative indications

“…117,118 In a propensitymatched analysis of women receiving HES 130/0.4 or balanced crystalloids, no association was observed between HES use and perioperative blood loss during caesarean delivery. 119 The fourth edition of The European guideline on management of major bleeding and coagulopathy following trauma recommends that isotonic crystalloid solutions are the first choice in fluid resuscitation in hypotensive trauma, and colloids should be avoided because of their adverse effects of haemostasis. 120 However, the latter is mainly based on studies in intensive care or septic patients, and novel RCTs are required to support the right choice of resuscitation fluids in acute traumatic bleeding.…”