title: Maternal hemoglobin decline following 'uneventful' cesarean delivery.
abstract: OBJECTIVE
  To assess hemoglobin (Hb) decline following elective and non-elective uneventful cesarean section (CS).
  
  
  METHODS
  A retrospective cohort study of all women with singleton pregnancy who underwent uneventful CS defined as clinical estimation of intra-operative bleeding < 1000 ml. Hemoglobin decline (pre- and post-CS levels difference) of women with non-elective CS (during labor/delivery process) were compared to those who underwent elective CS (no labor). Cases complicated by placenta previa/abruption were excluded.
  
  
  RESULTS
  Overall 2767 women underwent uneventful CS, of them, 954 (34.5%) were non-elective and 1813 (65.5%) were elective. Hemoglobin decline was higher in the non-elective group (1.5 ± 1.3 versus 1.0 ± 1.2 g/dL, p < 0.001). This was also observed in the nulliparous patients as well as in those with previous single CS subgroups. The rate of Hb decline ≥3 g/dL and the rate of post-CS Hb < 7 g/dL were higher in the non-elective group (8.9% versus 3.1%, p < 0.001 and 2.3% versus 0.4%, p = 0.001, respectively). On multivariable analysis, non-elective CS was found to be significantly associated with Hb decline of  ≥3 g/dl after surgery (aOR = 2.10, 95% CI 1.36-3.23, p = 0.001) and need for blood products transfusion (aOR = 2.24, 95% CI 1.04-4.83, p = 0.03).
  
  
  CONCLUSIONS
  Non-elective CS was associated with an increased risk of Hb decline and blood product transfusion even in an apparent uneventful operation.
authors.affiliation: a Helen Schneider Hospital for Women , Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Ashwal
authors.affiliation: a Helen Schneider Hospital for Women , Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
authors.forename: Avital
authors.initials: A
authors.lastname: Wertheimer
authors.affiliation: a Helen Schneider Hospital for Women , Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Aviram
authors.affiliation: a Helen Schneider Hospital for Women , Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Orbach-Zinger
authors.affiliation: a Helen Schneider Hospital for Women , Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Yogev
authors.affiliation: a Helen Schneider Hospital for Women , Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
authors.forename: Liran
authors.initials: L
authors.lastname: Hiersch
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods*; D007743:Labor, Obstetric; D006473:Postpartum Hemorrhage / Q000097:blood; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D006454:Hemoglobins
keywords: Cesarean section; cesarean delivery; elective; emergent; hemoglobin; hemorrhage