Average maternal hemoglobin decline after first elective cesarean section compared to higher order cesarean sections.

Area of Science:

• Obstetrics and Gynecology
• Surgical Outcomes
• Maternal Health

Background:

• Cesarean section (CS) can lead to scarring in the lower uterine segment.
• This scarring may influence blood loss in subsequent surgeries.
• Understanding blood loss patterns is crucial for surgical planning and patient safety.

Purpose of the Study:

• To compare average blood loss between first and repeat cesarean sections.
• To investigate the association between the number of cesarean sections and maternal blood loss.
• To explore factors influencing blood loss during cesarean delivery.

Main Methods:

• Retrospective comparison of maternal hemoglobin and hematocrit changes post-surgery.
• Analysis of data from 9401 cesarean sections (January 2010 - November 2020).
• Comparison of surgery length and blood transfusion requirements across groups (first, second, third+ CS).

Main Results:

• The highest drop in hemoglobin and hematocrit was observed after the first cesarean section.
• Repeat cesarean sections (third or more) were associated with significantly longer surgery times and higher rates of blood transfusion.
• First cesarean section, younger maternal age, and BMI >35 were linked to increased hemoglobin drop.

Conclusions:

• Despite longer procedures and higher transfusion rates in repeat cesarean sections, the initial cesarean delivery results in a greater average decrease in hemoglobin.
• Lower uterine segment scarring from the first cesarean section is a potential explanation for this observed difference in blood loss.
• These findings highlight the importance of considering uterine scarring in managing subsequent cesarean deliveries.