Anesth Pain Med.  2019 Oct;14(4):423-428. 10.17085/apm.2019.14.4.423.

Intraoperative continuous noninvasive hemoglobin monitoring in patients with placenta previa undergoing cesarean section: a prospective observational study

• Kim H
• Do SH
• Hwang JW
• Na HS

• KMID: 2465340
• DOI: http://doi.org/10.17085/apm.2019.14.4.423

Abstract

BACKGROUND
Obstetric patients with placenta previa are at risk for sever peripartum hemorrhage. Early detection of anemia and proper transfusion strategy are important for the management of obstetric hemorrhage. In this study, we assessed the utility and accuracy of noninvasive hemoglobin (SpHb) monitoring in patients with placenta previa during cesarean section.
METHODS
Parturients diagnosed with placenta previa and scheduled for cesarean section under spinal anesthesia were enrolled. SpHb and laboratory Hb (Lab-Hb) were measured during surgery as primary outcomes.
RESULTS
Seventy-four pairs of SpHb and Lab-Hb were collected from 39 patients. The correlation coefficient was 0.877 between SpHb and Lab-Hb (P < 0.001). The Bland-Altman plot showed a mean difference ± SD of 0.3 ± 0.8 g/dl between noninvasive Hb and Lab-Hb, and the limits of agreement were −1.2 to 1.8 g/dl. The magnitude of the difference between SpHb and Lab-Hb was < 0.5 g/dl in 64.9%; however, it was > 1.5 g/dl in 10.8%.
CONCLUSIONS
SpHb monitoring had a good correlation with Lab-Hb. A small mean difference between SpHb and lab-Hb might not be clinically significant; however, the limits of agreements were not narrow. In particular, SpHb could be overestimated in the anemic population. Based on our results, further studies investigating the accuracy and precision of SpHb monitoring should be performed in parturients presenting Hb below 10 g/dl.

Keyword

Cesarean section; Laboratory hemoglobin; Noninvasive hemoglobin

MeSH Terms

Anemia
Anesthesia, Spinal
Cesarean Section*
Female
Hemorrhage
Humans
Observational Study*
Peripartum Period
Placenta Previa*
Placenta*
Pregnancy
Prospective Studies*

Figure

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  Fig. 1 Change of noninvasive hemoglobin (SpHb) and perfusion index (Pi). OP: operation.

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  Fig. 2 Correlation between the laboratory hemoglobin (Lab-Hb) and noninvasive hemoglobin (SpHb). The correlation coefficient was 0.877 between the SpHb and Lab-Hb.

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  Fig. 3 Bland–Altman analysis for laboratory hemoglobin (Lab-Hb) and noninvasive hemoglobin (SpHb). The mean difference (one horizontal solid line) between the SpHb and Lab-Hb was 0.3 g/dl and the limits of agreement (two horizontal dash lines) were −1.2 to 1.8 g/dl.

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