Anesthesia technique and postpartum hemorrhage: a prospective cohort study
Técnica de anestesia e hemorragia pós-parto: um estudo de coorte prospectivo
Anderson Borovac-Pinheiro; Maria José Nascimento Brandão; Juliana Luz Passos Argenton; Thales Daniel Alves Barbosa; Rodolfo Carvalho Pacagnella
Abstract
Background and objective
During the past few years, an increased number of postpartum hemorrhages have been noticed, even in high-income countries. It has been suggested that this escalation could be associated with increased obstetric interventions. Among such interventions, anesthesia is one of the most prevalent. The present study aimed to investigate the influence of peripartum anesthesia on total blood loss during the 24 hours after delivery.
Methods
We performed a complementary analysis from a prospective cohort study that evaluated postpartum bleeding within 24 hours after birth. The study was performed between February 1st, 2015 and March 31st, 2016 at the Women’s Hospital at the Universidade Estadual de Campinas, Brazil. Postpartum bleeding was measured using a calibrated drape and summing the blood contained in the compresses and pads used for 24 hours. We calculated means, percentages, and standard deviation and performed Mann-Whitney analysis for the relation of anesthesia with Postpartum Hemorrhage (PPH) and logistic regression for drugs used in the anesthesia with PPH, using SAS 9.4 software.
Results
We included 270 women in the study; of these, 168 received anesthesia for delivery and almost 50% of them had spinal and epidural anesthesia. The mean blood loss within 24 hours after delivery did not show differences between those who did and those who did not receive obstetrical anesthesia (579.0 ± 361.6 vs. 556.6 ± 360.6; p = 0.57). Logistic regression showed that anesthesia, the type of anesthesia, and the drug used did not influence the PPH above 500 mL and above 1000 mL within 2 hours (p > 0.05).
Conclusion
Anesthesia did not influence postpartum bleeding after vaginal delivery.
Keywords
Resumo
Justificativa e objetivo: Nos últimos anos, observou-se um aumento no número de hemorragias pós-parto, mesmo em países de alta renda. Tem-se sugerido que este aumento pode estar associado ao aumento das intervenções obstétricas. Dentre tais intervenções, a anestesia é uma das mais prevalentes. O presente estudo teve como objetivo investigar a influência da anestesia periparto na perda total de sangue durante as 24 horas após o parto. Métodos: Foi realizada uma análise complementar a partir de um estudo de coorte prospectivo que avaliou o sangramento pós-parto em até 24 horas após o nascimento. O estudo foi realizado entre 1º de fevereiro de 2015 e 31 de março de 2016 no Hospital da Mulher da Universidade Estadual de Campinas, Brasil. O sangramento pós-parto foi medido com campo calibrado e somando o sangue contido nas compressas e absorventes utilizados por 24 horas. Calculamos médias, porcentagens e desvio padrão e realizamos análise de Mann-Whitney para a relação da anestesia com hemorragia pós-parto (HPP) e regressão logística para drogas utilizadas na anestesia com HPP, utilizando o software SAS 9.4. Resultados: Incluímos 270 mulheres no estudo; destas, 168 receberam anestesia para o parto e quase 50% deles receberam raquianestesia e peridural. A perda sanguínea média em até 24 horas após o parto não apresentou diferenças entre aquelas que receberam e aquelas que não receberam anestesia obstétrica (579,0 ± 361,6 vs. 556,6 ± 360,6; p = 0,57). A regressão logística mostrou que a anestesia, o tipo de anestesia e a droga utilizada não influenciaram a HPP acima de 500 mL e acima de 1000 mL em 2 horas (p > 0,05). Conclusão: A anestesia não influenciou o sangramento pós-parto após o parto vaginal.
Palavras-chave
References
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