Predictive Factors for the Development of Severe Hypocalcaemia during Surgery for Morbidly Adherent Placenta (MAP) [29E]. (May 2018)

• Record Type: Journal Article
• Authors: Erfani, Hadi; Fox, Karin A.; Shamshirsaz, Amir; Hui, Shiu-Ki; Shamshirsaz, Alireza; Belfort, Michael A.
• Is Part Of: Obstetrics and gynecology. Volume 131(2018)Supplement 1
• Publication Date: 2018-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000533048.65308.50
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Acute severe hypocalcemia is a life-threatening complication of massive blood transfusion that requires prompt treatment. Our objective was to determine potential predictive factors for severe hypocalcaemia in patients undergoing cesarean hysterectomy for MAP. METHODS: Retrospective study of 123 patients with pathologically proven MAP (accreta, increta or percreta) who underwent cesarean hysterectomy in our center between January 2011 and February 2017. Cases: critically low ("panic level") serum total Calcium (⩽ 7mg/dL) and Controls: normal serum total Calcium (≥8.5). Regression and ROC analyses were performed. RESULTS: There 13 cases with critically low Calcium and 18 controls with normal Calcium levels. Baseline patient characteristics were not different. The median estimated blood loss (EBL), units of PRBC's and volume of crystalloid (CT), were higher in the low Calcium group. 6/13 (46.2%) cases had received > 4 units of PRBC's during surgery versus 2/18 (11.1%) controls (P = 0.04). ROC showed that EBL, units of PRBC's and CT were useful in distinguishing patients who developed severe hypocalcaemia. Moreover, univariate regression analysis revealed that patients with EBL > 1500ml, those who received ≥4 units of PRBC's [OR = 6.9 (1.1-42.8)] and those with CT ≥4L [OR = 16.7 (2.8-99.7)] were at increased risk of developing severe hypocalcaemia. CONCLUSION: Transfusion of ≥4 units PRBC's and ≥4L crystalloid predict severe hypocalcaemia in MAP. These interventions are causally linked to EBL>1500ml. These data support the empiric replacement of calcium chloride after >4 units of PRBC's or >4L of crystalloid are rapidly transfused during cesarean hysterectomy for MAP.