Gluck Ohad, Mizrachi Yossi, Kovo Michal, Divon Michael, Bar Jacob, Weiner Eran
Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center Holon, and Sackler School of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel.
Department of Obstetrics and Gynecology, New York University School of Medicine, Lenox Hill Hospital, New York, NY, USA.
Arch Gynecol Obstet. 2017 Nov;296(5):907-913. doi: 10.1007/s00404-017-4506-6. Epub 2017 Sep 6.
The surgeons' visual estimation is the most widely used method for estimating blood loss (BL) while performing cesarean deliveries (CDs). Major BL underestimation may adversely influence obstetric decision making, and result in delaying interventions. Major BL overestimation may result in unnecessary costly interventions. Therefore, we aimed to identify independent predictors for major BL underestimation and overestimation during CDs.
All CDs performed between 11/2008 and 6/2016, in a university-affiliated hospital, were reviewed for demographic and surgical data, including the surgeons' reported estimated BL (EBL). Calculated BL (CBL) was calculated by multiplying the calculated maternal blood volume by the percent of hematocrit decrease. Multivariate logistic regressions were performed to identify independent risk factors for major BL underestimation (CBL-EBL ≥ 400 ml) and overestimation (EBL-CBL ≥ 400 ml).
During the study period, 3655 CDs were analyzed, of which 420 met the criterion for major BL underestimation and 1214 for major BL overestimation. Urgent surgery (aOR = 2.83; 95% CI 2.06-3.89), general anesthesia (aOR = 2.39; 95% CI 1.71-3.33), and higher surgeon experience (aOR = 1.03; 95% CI 1.01-1.06) were found to be independent risk factors for major BL underestimation, while any previous CD (aOR = 0.47; 95% CI 0.33-0.67) decreased the risk of underestimation. Any previous CD (aOR = 1.29; 95% CI 1.05-1.58) and intra-abdominal adhesions (aOR = 1.37; 95% CI 1.11-1.70) were found to be independent risk factors for major BL overestimation, while urgent CD (aOR = 0.50; 95% CI 0.41-0.60) decreased the risk of overestimation.
Various factors can predict major underestimation and overestimation of BL during CDs. Recognizing these factors can assist in the interpretation of visual EBL and improve obstetric decision making.
在剖宫产手术（CD）中，外科医生的视觉估计是估计失血量（BL）最常用的方法。严重低估失血量可能会对产科决策产生不利影响，并导致干预延迟。严重高估失血量可能会导致不必要的昂贵干预措施。因此，我们旨在确定剖宫产手术期间严重低估和高估失血量的独立预测因素。
回顾了2008年11月至2016年6月在一家大学附属医院进行的所有剖宫产手术的人口统计学和手术数据，包括外科医生报告的估计失血量（EBL）。计算失血量（CBL）通过将计算出的产妇血容量乘以血细胞比容下降百分比来计算。进行多因素逻辑回归分析，以确定严重低估失血量（CBL-EBL≥400ml）和高估失血量（EBL-CBL≥400ml）的独立危险因素。
在研究期间，分析了3655例剖宫产手术，其中420例符合严重低估失血量的标准，1214例符合严重高估失血量的标准。急诊手术（调整后比值比[aOR]=2.83；95%置信区间[CI]2.06-3.89）、全身麻醉（aOR=2.39；95%CI 1.71-3.33）和外科医生经验更丰富（aOR=1.03；95%CI 1.01-1.06）被发现是严重低估失血量的独立危险因素，而既往有剖宫产手术史（aOR=0.47；95%CI 0.33-0.67）可降低低估风险。既往有剖宫产手术史（aOR=1.29；95%CI 1.05-1.58）和腹腔粘连（aOR=1.37；95%CI 1.11-1.70）被发现是严重高估失血量的独立危险因素，而急诊剖宫产手术（aOR=0.50；95%CI 0.41-0.60）可降低高估风险。
多种因素可预测剖宫产手术期间失血量的严重低估和高估。认识到这些因素有助于解释视觉估计失血量，并改善产科决策。
