Re: Blood loss at Cesarean versus vaginal birth
From: Bernard Cristalli (bcrist@club-internet.fr)
Mon Jun 12 14:22:13 2000
Guillaume Magnin is a friend and this paper should be considered but:
it is a retrospective study, the pre-delivery work-up may be rather old for
VDs but is quite recent for C/Ss specially the elective ones. And anyway
spontaneous VDs are less bloody than assisted ones so you have to give moms
a chance.
These findings are worth a serious prospective controlled serie.
--
Bernard Cristalli MD AMACOG
AIHP - ACCA
Paris France
Bernard.Cristalli@CliniquedelEssonne.fr
http://www.CliniquedelEssonne.fr
http://www.obgyn.net/corresp/cristalli.htm
http://www.gyneweb.fr
'64 Mk2 3.8
> De : RModugno@aol.com
> Répondre à : ob-gyn-l@obgyn.net
> Date : Mon, 12 Jun 2000 08:12:41 -0500
> À : Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net>
> Objet : Blood loss at Cesarean versus vaginal birth
>
> Another argument for routine universal cesarean section:
> (Just stirring the yoogurt a bit ! )
>
> Comparison of blood loss during cesarean section and during vaginal delivery
> with episiotomy].
> Sarfati R, Marechaud M, Magnin G
> Service de Gynecologie-Obstetrique, Hopital Jean-Bernard, Poitiers.
>
> OBJECTIVE: The aim of our study was to compare blood loss during vaginal
> delivery with episiotomy and during cesarean section, to determine risk
> factors, and to determine whether clinical assessment of blood loss at
> delivery is well-evaluated. PATIENTS AND METHODS: We retrospectively matched
> 97 vaginal deliveries with episiotomy with 97 cesarean deliveries which has
> occurred between 1 November 1991 and 30 April 1993. Matching criteria were
> age, parity, term and birth weight. Blood loss at delivery was defined by a
> drop in hematocrit greater than 10% between the pre-delivery anesthesia
> work-up and the laboratory results 3 days post-partum. RESULTS: We found that
> hemoglobin and hematocrit fell more after vaginal deliveries than after
> cesarean section (p < 0.05 and p < 0.01). The fall in hemoglobin level and
> hematocrit were significantly greater after forceps delivery with episiotomy
> than after spontaneous vaginal delivery (p < 0.01 and p < 0.01). Among the
> vaginal deliveries, 11 showed laboratory criteria corresponding to blood loss
> at delivery despite clinical diagnosis in only 2 of them. Unwarranted
> clinical diagnosis of blood loss at delivery was however made 11 times after
> vaginal delivery and 19 times after cesarean (20%). CONCLUSION: Our findings
> demonstrate that blood loss during vaginal delivery with episiotomy is
> greater than during cesarean section and affirms the determining role of
> forceps use in association with episiotomy in this blood loss. Clinical
> assessment of blood loss at delivery lacks precision.
>
> PMID: 10394516, UI: 99322820
>
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> --
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> Robert Modugno MD MBA FACOG
> ------------------------------------------------------------------------------
> Marietta, GA
>
