title: Do prophylactic prostaglandins reduce the transfusion rate at cesarean section in high-order multiple pregnancies?
abstract: OBJECTIVE
  Cesarean section is the more usual mode of delivery in high-order multiple pregnancy (> or =3). Excessive uterine distension increases the risk of bleeding and the need for transfusion. The aim of this study was to investigate if prophylactic use of prostaglandins at cesarean section for high-order multiple pregnancies reduces blood loss and transfusion requirement based on historic data.
  
  
  METHODS
  We studied a prospective series of 28 parturients with high-order multiple pregnancy (group 2) who were treated, after clamping the last umbilical cord, with oxytocin (5IU intravenous then 35IU in a 24h infusion) combined with intravenous prostaglandin. A comparable retrospective series of 14 patients (group 1) had been given oxytocin alone at the same dose. Postoperative serum hemoglobin and transfusion rate as well as adverse effects were compared between the two groups. Student's t-test was used to compare continuous variables. Chi square test and Fisher exact test were used to compare categorical variables.
  
  
  RESULTS
  The two groups were comparable for anthropometric data and duration of pregnancy. None of the patients in group 2 required red cell transfusion while 21.4% of those in group 1 required transfusion. A significant lower decrease of postoperative haemoglobin is noted in group 2 (P=0.0006). Multivariate analysis using variables significant at univariate analysis and pre-eclampsia confirmed this difference. There were no adverse reactions to treatment.
  
  
  CONCLUSIONS
  In our experience, prophylactic prostaglandin infusion at cesarean section in high-order multiple pregnancy is associated with a lower need for per operative red cell transfusion and a higher postoperative hemoglobin level. This observation merits confirmation in larger studies.
authors.affiliation: Anesthesia and Intensive Care, Regional Maternity, 10 rue Docteur Heydenreich, 54042 Nancy, France. f.bayoumeu@maternite.chu-nancy.fr
authors.forename: F
authors.initials: F
authors.lastname: Bayoumeu
authors.forename: N E
authors.initials: NE
authors.lastname: Baka
authors.forename: J
authors.initials: J
authors.lastname: Fresson
authors.forename: P
authors.initials: P
authors.lastname: Monnier-Barbarino
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002585:Cesarean Section; D005260:Female; D005307:Fertilization in Vitro; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D015999:Multivariate Analysis; D011182:Postoperative Care; D019106:Postoperative Hemorrhage; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011300:Preoperative Care; D011446:Prospective Studies; D011453:Prostaglandins / Q000009:adverse effects / Q000627:therapeutic use*; D014593:Uterine Inertia / Q000628:therapy
chemical_list: D006454:Hemoglobins; D011453:Prostaglandins; D007501:Iron