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Intraoperative continuous noninvasive hemoglobin monitoring in patients with placenta previa undergoing Cesarean section: prospective observational study
Abstract Number: F3H-228
Abstract Type: Original Research
Background: Obstetric patients with placenta previa are at risk for peripartum severe hemorrhage, which occur rapidly and unexpectedly. Early detection of anemia and following proper transfusion strategy are important for the management of obstetric hemorrhage. In this study, we assessed the utility and accuracy of noninvasive hemoglobin monitoring in patients with placenta previa during Cesarean section.
Methods: Parturients diagnosed with placenta previa and scheduled for Cesarean section under spinal anesthesia were enrolled. Noninvasive hemoglobin (SpHb) was measured by using the Radical-7 Pulse CO-oximeter (Masimo Corp., Irvine, CA, USA). Primary outcomes were the SpHb and Lab-Hb. Secondary outcomes were infused fluid volume, unit of transfusion, calculated blood loss during the operation, and urine output.
Results: Total 74 pairs of SpHb and Lab-Hb were collected from 39 patients. The correlation coefficient was 0.877 between the SpHb and Lab-Hb (P <0.001). The Bland-Altman plot showed the mean difference ± SD as 0.3 ± 0.8 g/dl between noninvasive Hb and Lab-Hb, and the limits of agreement were -1.2 to 1.8 g/dl. The magnitude of the difference between the SpHb and Lab-Hb was < 0.5 g/dl in 64.9% of patients; however, 14.8% of measurements had a difference of > 1.0 g/dl.
Conclusion: Noninvasive Hb monitoring had good correlation with laboratory Hb. Small mean difference between the noninvasive SpHb and lab-Hb might not be clinically significant; however, the limit of agreements was not narrow. In particular, SpHb could be overestimated in anemic population. Based on our results, further studies investigating accuracy and precision of noninvasive Hb monitoring should be performed in parturient presenting Hb below 10 g/dl.