Methods identified to reduce bleeding after cesarean delivery

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Data has supported 2 novel methods of reducing postpartum hemorrhage risk after cesarean delivery, as discussed at the ANESTHESIOLOGY 2023 annual meeting.

Methods identified to reduce bleeding after cesarean delivery | Image Credit: © Fred Facker - © Fred Facker - stock.adobe.com.

Methods identified to reduce bleeding after cesarean delivery | Image Credit: © Fred Facker - © Fred Facker - stock.adobe.com.

Severe postpartum bleeding, also known as postpartum hemorrhage, can be prevented after cesarean delivery through calcium chloride infusion and an early warning system, according to data presented at the ANESTHESIOLOGY 2023 annual meeting.

Takeaways

  1. Severe postpartum bleeding (postpartum hemorrhage) can be prevented after cesarean delivery through 2 key methods: calcium chloride infusion and an early warning system.
  2. Postpartum hemorrhage is the leading cause of maternal mortality during childbirth in the United States, and it is more common following cesarean deliveries compared to vaginal births.
  3. A trial involving over 120 women undergoing cesarean delivery found that calcium chloride infusion significantly reduced the incidence of postpartum hemorrhage compared to a placebo.
  4. An early warning system, involving a simple uterine tone scoring system, was shown to be effective in identifying cases of poor uterine contraction and increased risk of postpartum hemorrhage.
  5. Both the calcium chloride infusion and the early warning system are simple, cost-effective solutions that can be particularly valuable in low-resource settings to reduce the risk of postpartum hemorrhage during cesarean deliveries.

Postpartum hemorrhage is the leading cause of maternal mortality at birth in the United States and is more common following cesarean delivery compared to vaginal birth. Eighty percent of postpartum hemorrhage cases are caused by uterine atony, a condition where the uterus remains soft and weak after delivery rather than contracting.

“Bleeding during a cesarean delivery is a high-stakes, high - risk situation, and when it occurs, the obstetrics and anesthesia teams must work together to rapidly prevent and treat ongoing bleeding,” said James Xie, MD, lead author of the warning study.

The first method,calcium chloride infusion, was evaluated because it is a cheap, safe, and simple method which can be used in low-resource settings, where mortality from postpartum hemorrhage is more common. Over 120 women needing a cesarean delivery after labor with an oxytocin infusion were included in a trial evaluating calcium chloride infusion. 

Participants were randomly assigned to receive 1-gram infusions of calcium chloride or a placebo. Postpartum hemorrhage was reported in 40% of participants receiving calcium chloride compared to 57% receiving placebo. Researchers found the amount of bleeding in patients during cesarean delivery was reduced by over 200 mL from calcium chloride.

The second method, an early warning system, was evaluated through an alert that appears on an anesthesiologist’s electronic health record 2 minutes after delivery, requesting a uterine score from 1 to 10. The score is obtained by an obstetrician manually feeling the uterine tone, with scores below 6 indicating poor contraction and increased risk of postpartum hemorrhage.

Over 1000 cesarean deliveries were included in the analysis. Patients received 3 separate assessments of uterine tone score, the first being 2 minutes after delivery, the second 7 minutes after delivery, and the third 12 minutes after delivery. Scores of 6 or lower at 12 minutes were reported in 18% of women, 77% of which experienced hemorrhage.

“Our research shows that this simple scoring system is a very meaningful, easy way to ensure that if the uterus is contracting poorly and there is a risk of hemorrhage, it will be recognized by their health care team early,” said Xie.

Reference

Two easy fixes could reduce bleeding after cesarean delivery. American Society of Anesthesiologists. October 14, 2023. Accessed October 17, 2023.

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