title: Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis.
abstract: Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use.
  
  
  
  We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group).
  
  
  
  Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intraoperative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group.
  
  
  
  Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.
authors.affiliation: Department of Anesthesiology, University of Virginia, P.O. Box 800710, Charlottesville, VA, 22908, USA.|Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.|Outcomes Research Consortium, Cleveland, OH, USA.
authors.forename: Abdullah S
authors.initials: AS
authors.lastname: Terkawi
authors.affiliation: Department of Obstetrics and Gynecology, University of Virginia, P.O. Box 800712, Charlottesville, VA, 22908, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Larkin
authors.affiliation: Department of Epidemiology, Columbia University, 772 West 168th Street, New York, NY, 10032, USA.
authors.forename: Siny
authors.initials: S
authors.lastname: Tsang
authors.affiliation: Department of Anesthesiology, University of Virginia, P.O. Box 800710, Charlottesville, VA, 22908, USA.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Sheeran
authors.affiliation: Department of Anesthesiology, University of Virginia, P.O. Box 800710, Charlottesville, VA, 22908, USA. Mt9y@virginia.edu.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tiouririne
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000379:methods; D001777:Blood Coagulation; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000379:methods*; D000077324:Crystalloid Solutions; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007022:Hypotension / Q000209:etiology; D007552:Isotonic Solutions / Q000008:administration & dosage*; D010656:Phenylephrine / Q000008:administration & dosage; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D010656:Phenylephrine; D004809:Ephedrine
keywords: Blood loss; Cesarean delivery; Hydroxyethyl starch