Ashwal Eran, Wertheimer Avital, Aviram Amir, Orbach-Zinger Sharon, Yogev Yariv, Hiersch Liran
a Helen Schneider Hospital for Women , Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
J Matern Fetal Neonatal Med. 2016 Sep;29(18):3061-5. doi: 10.3109/14767058.2015.1114086. Epub 2015 Nov 30.
To assess hemoglobin (Hb) decline following elective and non-elective uneventful cesarean section (CS).
A retrospective cohort study of all women with singleton pregnancy who underwent uneventful CS defined as clinical estimation of intra-operative bleeding < 1000 ml. Hemoglobin decline (pre- and post-CS levels difference) of women with non-elective CS (during labor/delivery process) were compared to those who underwent elective CS (no labor). Cases complicated by placenta previa/abruption were excluded.
Overall 2767 women underwent uneventful CS, of them, 954 (34.5%) were non-elective and 1813 (65.5%) were elective. Hemoglobin decline was higher in the non-elective group (1.5 ± 1.3 versus 1.0 ± 1.2 g/dL, p < 0.001). This was also observed in the nulliparous patients as well as in those with previous single CS subgroups. The rate of Hb decline ≥3 g/dL and the rate of post-CS Hb < 7 g/dL were higher in the non-elective group (8.9% versus 3.1%, p < 0.001 and 2.3% versus 0.4%, p = 0.001, respectively). On multivariable analysis, non-elective CS was found to be significantly associated with Hb decline of ≥3 g/dl after surgery (aOR = 2.10, 95% CI 1.36-3.23, p = 0.001) and need for blood products transfusion (aOR = 2.24, 95% CI 1.04-4.83, p = 0.03).
Non-elective CS was associated with an increased risk of Hb decline and blood product transfusion even in an apparent uneventful operation.
评估择期及非择期无并发症剖宫产术后血红蛋白（Hb）的下降情况。
对所有单胎妊娠且接受无并发症剖宫产的女性进行回顾性队列研究，无并发症剖宫产定义为术中出血量临床估计<1000ml。将非择期剖宫产（分娩过程中）女性的血红蛋白下降情况（剖宫产前后水平差异）与择期剖宫产（未经历分娩）女性进行比较。排除前置胎盘/胎盘早剥合并的病例。
共有2767名女性接受了无并发症剖宫产，其中954例（34.5%）为非择期剖宫产，1813例（65.5%）为择期剖宫产。非择期剖宫产组的血红蛋白下降幅度更大（1.5±1.3对比1.0±1.2g/dL，p<0.001）。初产妇以及既往有单次剖宫产史的亚组中也观察到了这一情况。非择期剖宫产组血红蛋白下降≥3g/dL的比例以及术后血红蛋白<7g/dL的比例更高（分别为8.9%对比3.1%，p<0.001；2.3%对比0.4%，p=0.001）。多变量分析显示，非择期剖宫产与术后血红蛋白下降≥3g/dl（调整后比值比[aOR]=2.10，95%置信区间[CI]1.36 - 3.23，p=0.001）以及输血需求显著相关（aOR=2.24，95%CI 1.04 - 4.83，p=0.03）。
即使是表面上无并发症的手术，非择期剖宫产也与血红蛋白下降及输血风险增加相关。
