.: ORİJİNAL ARAŞTIRMA
Association of Fibrinogen Use in Cesarean Delivery with Bleeding and Blood Products in Patients with Plasenta Acreata Spectrum: A Retrospective Study
Sezaryen Doğumda Fibrinojen Kullanımının Plasenta Akreata Spektrumlu Hastalarda Kanama ve Kan Ürünü ile İlişkisi: Retrospektif Bir Çalışma
Turkiye Klinikleri J Anest Reanim. 2023;21(2):53-60
doi: 10.5336/anesthe.2023-98454
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Placenta accreta spectrum (PAS) is a condition with a high risk of perioperative bleeding that can cause maternal morbidity and mortality. Fibrinogen is the first factor of which level decreases in case of perioperative bleeding, although it increases in the last trimester of pregnancy. In this retrospective study, we aimed to evaluate the effect of fibrinogen use on preoperative and postoperative outcomes in PAS patients with high bleeding risk. Material and Methods: In this study, the files of 171 patients who were operated on with the diagnosis of antenatal PAS were examined retrospectively. Patients were divided into two groups according to fibrinogen use. Demographic data of both groups, choice of anesthesia, surgical application, amount of fluid, blood and blood product used peroperatively, amount of bleeding and postoperative complications were evaluated. Results: A total of 146 patients were included in the study. Patients were divided into two groups: group without fibrinogen concentrate (GNF, n=93) and group with fibrinogen concentrate (GF, n=53). The amount of preoperative bleeding, blood utilization and the total amount of fluid given was higher in GF compared to GNF (p<0.05). Postoperative hospital and intensive care unit (ICU) hospitalization history was higher in GF (p<0.05). Conclusion: Fibrinogen concentrate can be used according to the amount of bleeding regardless of the preoperative fibrinogen value in case of bleeding in patients undergoing cesarean section with antenatal PAS. In these patients, anaesthesia management should be determined with a multidisciplinary approach by planning preoperative blood and blood products preparation and ICU according to bleeding and surgical method.
Keywords: Fibrinogen concentrate; placenta acreata spectrum; peroperative bleeding
Objective: Placenta accreta spectrum (PAS) is a condition with a high risk of perioperative bleeding that can cause maternal morbidity and mortality. Fibrinogen is the first factor of which level decreases in case of perioperative bleeding, although it increases in the last trimester of pregnancy. In this retrospective study, we aimed to evaluate the effect of fibrinogen use on preoperative and postoperative outcomes in PAS patients with high bleeding risk. Material and Methods: In this study, the files of 171 patients who were operated on with the diagnosis of antenatal PAS were examined retrospectively. Patients were divided into two groups according to fibrinogen use. Demographic data of both groups, choice of anesthesia, surgical application, amount of fluid, blood and blood product used peroperatively, amount of bleeding and postoperative complications were evaluated. Results: A total of 146 patients were included in the study. Patients were divided into two groups: group without fibrinogen concentrate (GNF, n=93) and group with fibrinogen concentrate (GF, n=53). The amount of preoperative bleeding, blood utilization and the total amount of fluid given was higher in GF compared to GNF (p<0.05). Postoperative hospital and intensive care unit (ICU) hospitalization history was higher in GF (p<0.05). Conclusion: Fibrinogen concentrate can be used according to the amount of bleeding regardless of the preoperative fibrinogen value in case of bleeding in patients undergoing cesarean section with antenatal PAS. In these patients, anaesthesia management should be determined with a multidisciplinary approach by planning preoperative blood and blood products preparation and ICU according to bleeding and surgical method.
Keywords: Fibrinogen concentrate; placenta acreata spectrum; peroperative bleeding
ÖZET
Amaç: Plasenta akreata spektrumu (PAS) perioperatif kanama riski yüksek maternal morbidite ve mortaliteye neden olabilen bir durumdur. Fibrinojen ise gebeliğin son trimesterinde yükselmesine rağmen perioperatif kanama durumunda düzeyi ilk azalan faktördür. Bu retrospektif çalışmada amacımız, kanama riski yüksek PAS hastalarında fibrinojen kullanımının perioperatif ve postoperatif sonuçlara etkisini değerlendirmektir. Gereç ve Yötemler: Bu çalışmada antenatal PAS tanısı ile opere olan 171 hastanın dosyaları geriye yönelik incelendi. Hastalar fibrinojen kullanımına göre göre iki gruba ayrıldı. Her iki grubun demografik verileri, anestezi seçimi, Cerrahi uygulama, sıvı miktarı, kan ve kan ürünü, intraoperatif kanama miktarı ve ameliyat sonrası komplikasyonlar değerlendirildi. Bulgular: Çalışmaya toplam 146 hasta dâhil edildi. Hastalar fibrinojen konsantresi kullanılmayan grup (GNF, n=93), fibrinojen konsantresi kullanılan grup (GF, n=53) olmak üzere 2 gruba ayrıldı. GF'de perioperatif kanama miktarı, kan kullanımı ve verilen toplam sıvı miktarı GNF'ye göre daha fazlaydı (p<0,05). Postoperatif hastane ve yoğun bakım ünitesi (YBÜ) yatış öyküsü GF'de daha fazlaydı (p<0,05). Sonuç: Antenatal PAS ile sezaryen yapılan hastalarda kanama olması durumunda perioperatif fibrinojen değerine bakılmaksızın, kanama miktarına göre fibrinojen konsantresi kullanılabilir. Bu hastalarda kanama ve cerrahi yönteme göre perioperatif kan ve kan ürünleri hazırlığı ve YBÜ planlanarak multidisipliner yaklaşımla anestezi yönetimi belirlenmelidir.
Anahtar Kelimeler: Fibrinojen konsantresi; plasenta akreata spektrum; perioperatif kanama
Amaç: Plasenta akreata spektrumu (PAS) perioperatif kanama riski yüksek maternal morbidite ve mortaliteye neden olabilen bir durumdur. Fibrinojen ise gebeliğin son trimesterinde yükselmesine rağmen perioperatif kanama durumunda düzeyi ilk azalan faktördür. Bu retrospektif çalışmada amacımız, kanama riski yüksek PAS hastalarında fibrinojen kullanımının perioperatif ve postoperatif sonuçlara etkisini değerlendirmektir. Gereç ve Yötemler: Bu çalışmada antenatal PAS tanısı ile opere olan 171 hastanın dosyaları geriye yönelik incelendi. Hastalar fibrinojen kullanımına göre göre iki gruba ayrıldı. Her iki grubun demografik verileri, anestezi seçimi, Cerrahi uygulama, sıvı miktarı, kan ve kan ürünü, intraoperatif kanama miktarı ve ameliyat sonrası komplikasyonlar değerlendirildi. Bulgular: Çalışmaya toplam 146 hasta dâhil edildi. Hastalar fibrinojen konsantresi kullanılmayan grup (GNF, n=93), fibrinojen konsantresi kullanılan grup (GF, n=53) olmak üzere 2 gruba ayrıldı. GF'de perioperatif kanama miktarı, kan kullanımı ve verilen toplam sıvı miktarı GNF'ye göre daha fazlaydı (p<0,05). Postoperatif hastane ve yoğun bakım ünitesi (YBÜ) yatış öyküsü GF'de daha fazlaydı (p<0,05). Sonuç: Antenatal PAS ile sezaryen yapılan hastalarda kanama olması durumunda perioperatif fibrinojen değerine bakılmaksızın, kanama miktarına göre fibrinojen konsantresi kullanılabilir. Bu hastalarda kanama ve cerrahi yönteme göre perioperatif kan ve kan ürünleri hazırlığı ve YBÜ planlanarak multidisipliner yaklaşımla anestezi yönetimi belirlenmelidir.
Anahtar Kelimeler: Fibrinojen konsantresi; plasenta akreata spektrum; perioperatif kanama
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