Sezaryen ile ilişkili kan nakli riskini artıran durumlar: Tek merkezli kohort çalışması

Conditions that increase the risk of cesarean- related blood transfusions: a single-center cohort study

Mehmet Murat IŞIKALAN, Eren Berkay ÖZKAYA, Büşra ÖZKAYA, Nurullah ŞENGÜL, Enes FERLİBAŞ, Ali ACAR

Özet

Amaç: Bu çal›flma, sezaryen do¤um yapan hastalarda kan nakli olma olas›l›¤›n› art›ran durumlar› tan›mlamay› amaçlamaktad›r. Yöntem: Çal›flma, Konya’da bulunan bir üniversite hastanesinde Ocak 2016 ve May›s 2020 tarihleri aras›nda gerçeklefltirildi. Çal›fl- maya sezaryen do¤um yapan gebeler dahil edildi. Uygun 4303 has- tan›n 188’i nakil grubunda iken 4115’i nakil olmayan grupta idi. Potansiyel kar›flt›r›c› faktörler için lojistik regresyon analizi yap›l- d›. Bulgular: Bu çal›flmada toplam 4303 uygun hasta de¤erlendirildi. Nakil olmayan grupta 4115 (%95.6) hasta yer ald›. Nakil grubu ise 188 (%4.4) hastadan oluflmaktayd›. Nakil olas›l›¤›; plasenta previa, plasenta akreta spektrumu, trombositopeni, preoperatif anemi, 4500 gram›n üzerinde makrozomi ve ço¤ul gebeli¤i olan gebelerde daha yüksekti [düzeltilmifl OR de¤erleri (%95 CI) s›ras›yla 10.58 (aral›k: 4.75–23.57), 7.75 (aral›k: 3.22–18.61), 7.85 (aral›k: 3.46–17.79), 5.71 (aral›k: 4.21–7.74), 4.22 (aral›k: 1.21-14.67) ve 2.10 (aral›k: 1.18- 3.72)]. Makrozomi seviyesi 4000–4500 gram aras›nda olan, uterin fib- roid, preeklampsi, erken membran rüptürü, daha önce sezaryen geç- mifli ve gestasyonel diabetes mellitus olan hastalarda nakil olas›l›¤›n- da art›fl olmad›. Sonuç: Plasenta previa, plasenta akreta spektrum, trombositope- ni, preoperatif anemi, 4500 gram›n üzerinde makrozomi ve ço¤ul gebelikler, nakil olas›l›¤›n› art›rmaktad›r. Bu tür hastalarda peri- operatif kan haz›rl›¤› hayati öneme sahiptir. Nakil olas›l›¤›n› azalt- mak için gebelik esnas›nda aneminin önlenmesi çok önemlidir.

Abstract

Objective: This study aimed to define the conditions that increase the possibility of receiving a blood transfusion in patients who had a cesarean section. Methods: This study was conducted between January 2016 – May 2020 in a university hospital located in Konya, Turkey. Pregnant women undergoing cesarean section were included. Of 4303 eligible patients, 188 women were the transfused group and 4115 women were the non-transfused group. Logistic regression analysis was per- formed for potential confounding factors. Results: A total of 4303 eligible patients were evaluated in this study. There were 4115 patients (95.6%) in the non-transfused group. The transfused group consisted of 188 patients (4.4%). The probability of transfusion was higher in pregnant women with placenta previa, pla- centa accreta spectrum, thrombocytopenia, preoperative anemia, macrosomia above 4500 g, and multiple gestations [adjusted OR val- ues (95% CI); 10.58 (range 4.75–23.57), 7.75 (range 3.22–18.61), 7.85 (range 3.46–17.79), 5.71 (range 4.21–7.74), 4.22 (range 1.21-14.67) and 2.10 (range 1.18-3.72), respectively]. There was no increase in the possibility of transfusion in 4000–4500 gram macrosomia, uterine fibroids, preeclampsia, premature rupture of membranes, previous cesarean sections and gestational diabetes mellitus. Conclusion: Placenta previa, placenta accreta spectrum, thrombo- cytopenia, preoperative anemia, macrosomia above 4500 g and mul- tiple gestations increase the possibility of transfusion. Perioperative blood preparation is vital in such patients. Prevention of anemia dur- ing pregnancy is critical in reducing transfusions