الفهرس 
PHYSIOLOGICAL BLOOD CHANGES DURING PREGNANCYOnly 14 pages are availabe for public view
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Abstract
Cesarean section is one of the most commonly performed operations throughout the world. The increased volume of blood loss during cesarean section may result in poor clinical outcome. Many factors would be implicated to affect intra-operative blood loss during cesarean section including; maternal causes such as weight, parity and previous CS, fetal causes like multiple gestation, polyhydramnious and malpresentation, technical causes; operative time, type of incision, placental separation technique, placental position and the type of anesthesia.
Consequently, accurate estimation of operative blood loss during cesarean section is crucially important to decrease peri-operative morbidity and avoidance of the risks associated with unnecessary blood transfusion. Nevertheless, the estimation process is still difficult and inaccurate with no ideal method to be relied on.
The aim of this study was to detect the optimal time for implementation of hemoglobin level measurement after cesarean section as a simple tool to assess the amount of intra operative blood loss in order to avoid exaggerated actions based on over and underestimation of the blood loss.
This study was conducted on 100 pregnant women undergoing cesarean section at Ain Shams University, Maternity Hospital. Cairo. Egypt. A written informed consent was taken from each patient before starting the research and after explanation of the nature, scope and possible consequences of the study. The women’ data including personal, obstetric, menstrual, medical and surgical history, clinical examination and investigations were recorded in a specially prepared sheet.
All women had undergone a lower segment cesarean section. Operative data including; surgeon rank, type of anesthesia, duration of surgery, placental position, methods of placental separation, difference in weight of surgical swabs before and after surgery, intravenous fluids infused and intra operative medications used were also recorded.
Complete blood count samples at different intervals immediately after cesarean section at skin closure, two hours, 24 hours, 48 hours and one week after surgery had been collected.
Post operative data were recorded which including; vital signs, intravenous fluids, medications and amount of post partum bleeding.
The pre-operative Hemoglobin concentration in all studied women ranged from 8.2 to 14.1 gram/deciliter with a mean of 11.39± 1.3 gram/deciliter. Hemoglobin levels were chosen rather than hematocrit levels because they are directly measured, not calculated and in some cases it can be very misleading.
During operation the amount of blood lost was estimated by calculating the difference between the weights of surgical swabs before and after the operation. This weight difference ranged from 93 to 775 grams with a mean of 385.95± 147.61 grams. Each 1 gram of weight difference is almost equal to 1 ml of blood).
In the present study, the delta changes of the difference between pre and post operative hemoglobin level in all studied women were calculated. Where, the highest difference was found between the preoperative hemoglobin and the two hours post operative hemoglobin with a mean of -0.0925± 0.06. Conversely, the lowest difference was between the preoperative hemoglobin and the one week post operative with a mean of -0.0236± 0.05.
This study revealed a highly significant correlation between the amount of blood loss (estimated by weight difference of surgical swabs) and the calculated delta changes between pre and post operative hemoglobin levels. Whereas, the most significant correlation was found between the amount of blood loss and the difference between pre operative hemoglobin level and the one week post operative value.