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Impact of "natural" cesarean delivery on peripartum blood loss: a randomized controlled trial
Noah Zafran1, Gali Garmi1, Suzan Abdelgani2
1Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel (Drs Zafran, Garmi, and Abdelgani, Ms Inbar, and Drs Romano and Salim); The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Drs Zafran, Garmi, Romano, and Salim).
Background:
Early skin-to-skin contact after vaginal delivery increases milk production and may increase oxytocin release, leading to a reduction in the rate of postpartum hemorrhage.
Objective:
This study aimed to examine the effect of "natural" cesarean deliveries on perioperative maternal blood loss.
Study Design:
This was a randomized controlled trial conducted at a single university-affiliated medical center, between August 2016 and February 2018. Term singleton pregnancies scheduled for a planned cesarean delivery under spinal anesthesia were included. Women were randomized at a ratio of 1:1 to natural cesarean delivery (study group) or traditional cesarean delivery (control group) during the routine preoperative assessment. Women in the study group watched fetal extraction, had early skin-to-skin contact, and breastfed until the end of surgery. Neonates in the control group were presented to the mother for a few minutes. Blood samples were drawn from all women, during fascia closure, to determine oxytocin levels using an enzyme-linked immunosorbent assay kit. The laboratory component was performed after recruitment completion and was accomplished in February 2019. The primary outcome was postpartum hemoglobin levels. To detect a difference of 0.5 g/dL between the groups with α=0.05 and β=80%, 214 women were needed.
Results:
Of 214 randomized women, 23 were excluded. There was no difference in demographic and obstetrical variables between the groups. Postpartum hemoglobin levels were 10.1±1.1 and 10.3±1.3 g/dL in the study and control groups, respectively (P=.19). There was no difference in the rates of postpartum hemorrhage and blood transfusion. Maternal pain scores, satisfaction, and exclusive breastfeeding were comparable. Maternal oxytocin blood levels were 389.5±183.7 and 408.5±233.6 pg/mL in the study and control groups, respectively (P=.96). The incidence of neonatal hypothermia was comparable between the groups (P=.13).
Conclusion:
Natural cesarean delivery did not affect perioperative hemoglobin level or maternal oxytocin blood concentration.
