Estimation of fall in hemoglobin and hematocrit in uneventful cesarean section

Objective: Hemorrhage still continues to be reported as one of the leading causes of maternal mortality and morbidity. Intraoperative estimation of the blood loss seems to be complex and misleading as it is impaired by the amount of amniotic fluid and blood from the placenta. However intraoperative visual assessment of blood loss is widely practiced by operating surgeon and anesthetist. The present study was aimed to find decline in Hemoglobin (Hb), hematocrit (Hct) and loss of percent blood volume in an uneventful cesarean section in a low risk patient population.
Material and methods: A retrospective study was carried out in the Dptt. Of Obs& Gynae from Nov 18 to January 19 in NDMC Medical College and Hindu Rao Hospital. Out of 140 cases of cesarean, 104 patients who were free from hemorrhage risks and experienced an uneventful elective cesarean section were included in the study. Cases with antepartum hemorrhage, blood transfusion, rupture uterus or surgical complications were excluded. The preoperative and post op Hb and Hct values were noted from case records. The post -operative decline in hemoglobin and hematocrit values were calculated and loss of percentage blood volume was calculated from the pre and postop values of hematocrit.
Results: The average preoperative and postoperative hemoglobin values were found to be 11.4 and 10.1±1.37 g/dl, respectively. The average decrease in Hb was 1.3± 0.67 g/dl. Mean pre and post- op haematocrit was 33.7 ± 3.34 and 30.16 ±3.56 respectively. The average fall in Hct was 3.5 ± 1.66. The average percentage of blood volume lost was calculated to be 10.5 ± 5 % in an uneventful cesarean.
Conclusion: Visual estimate of blood loss is a reliable method to assess intra-operative blood loss in uneventful cesarean section. After a routine uneventful cesarean, one should expect a fall in Hbby 1.3 g% .67 and fall in Hctby 3.5 1.66. This amounts to a loss of 10.5%  4.98 percentage of blood volume. Routine postoperative hemoglobin measurement after an uncomplicated cesarean section in low-risk women is only reassuring but not necessary and may be eliminated.