Abstract
Obstetric patients diagnosed with abnormal placentation (placenta accreta, increta
or percreta) are at increased risk of major postpartum hemorrhage and cesarean hysterectomy.
Obstetric anesthesiologists are primarily involved in intraoperative transfusion management
in these cases. Hemoglobin assessment is invaluable for assisting transfusion decision-making
during the acute period of obstetric hemorrhage. However, laboratory and point-of-care
tests of hemoglobin concentration are time-dependent and intermittent, and do not
provide a real-time assessment of change during the acute phase of blood loss. A new
non-invasive hemoglobin monitor has been introduced recently, which provides real-time
measurement of hemoglobin values (SpHb) using multi-wavelength pulse co-oximetry.
We present a review of five patients with suspected abnormal placentation who received
SpHb monitoring during cesarean hysterectomy at our institution. We discuss the potential
clinical utility of non-invasive hemoglobin monitoring for pregnant patients at high
risk of obstetric hemorrhage, and the potential role of SpHb in guiding transfusion
therapy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of Obstetric AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Placenta previa, placenta accreta, and vasa previa.Obstet Gynecol. 2006; 107: 927-941
- Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies.Anesthesiology. 2006; 105: 198-208
- Guidelines for the clinical use of red cell transfusions.Br J Haematol. 2001; 113: 24-31
- Practice parameter for the use of red blood cell transfusions: developed by the Red Blood Cell Administration Guideline Development Task Force of the College of American Pathologists.Arch Pathol Lab Med. 1998; 122: 130-138
- Transfusion therapy in postpartum hemorrhage.Semin Perinatol. 2009; 33: 124-127
- American Society of Anesthesiologists Committee on Transfusion Medicine. Current transfusion practices of members of the American Society of Anesthesiologists: A Survey.Anesthesiology. 2003; 99: 1433-1443
- The measurement of dyshemoglobins and total hemoglobin by pulse oximetry.Curr Opin Anaesthesiol. 2008; 21: 805-810
- Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review.Obstet Gynecol. 2010; 115: 637-644
- Optimal management strategies for placenta accreta.BJOG. 2009; 116: 648-654
Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2008. Hyattsville, MD: National Center for Health Statistics. Natl Vital Stat Rep 2010;58: No. 16.
- Trends in postpartum hemorrhage in high resource countries: a review, recommendations from the International Postpartum Hemorrhage Collaborative Group.BMC Pregnancy Childbirth. 2009; 9: 55
- Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions.BJOG. 2006; 113: 919-924
- The appropriateness of red blood cell transfusions in the peripartum patient.Obstet Gynecol. 2004; 104: 1000-1004
- Complications of massive transfusion.Chest. 2010; 137: 209-220
Richard KM, Quill TJ, Surgenor SD, Trummel JM, Koff MD. Evaluation of Non-invasive Hemoglobin Measurements on High Risk Surgical Patients. Annual Meeting of the American Society of Anesthesiologists Annual Meeting, San Diego, CA. 2010: A187.
Barr SJ, Collier CL, Applegate RL, Rook J, Allard M. Comparison of Pulse Hemoglobin to Arterial Blood Gas Hemoglobin during Major Surgical Procedures. American Society of Anesthesiologists, Annual Meeting, San Diego, CA. 2010: A1151.
- The accuracy of noninvasive and continuous total hemoglobin measurement by pulse CO-Oximetry in human subjects undergoing hemodilution.Anesth Analg. 2010; 111: 1424-1426
Article info
Publication history
Published online: June 06, 2011
Accepted:
March 29,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
