A Strategy of "Resistance Blood Management" in Pregnant Women at Risk of Massive Obstetric Hemorrhage

Abstract

The purpose of the study: To determine the effectiveness of treatment of anemia with intravenous iron (III) hydroxide sucrose complex (Sufer) in pregnant women with pathological placentation, as the first stage of "patient blood management" before delivery. Our studies have been limited to examining the effectiveness of an iron supplement for the treatment of anemia. Methods: Among 86 pregnant women with placental pathology, 58 (70.7%) had anemia. Severe anemia with a hemoglobin level <70 g/l was in 13 (22.4%), and moderate anemia with a hemoglobin level <90 g/l - in 19 (32.8%). The first group included 18 (31.1%), pregnant women, with placenta previa with periodic blood loss during pregnancy. The second group consisted of 40 (68.9%) pregnant women with the invasive placenta. The gestation period in all women was 33 + 6 weeks. Anemia was treated by administering intravenous iron Sufer 3 times a week (5-7 injections). Results: The main factor that led to pathological placentation was the scar on the uterus. In pregnant women of the second group with invasive placenta, the scar on the uterus was in 38 (95%) women. Severe anemia was present in 2 (11.1%) pregnant women with placenta previa and 2.4 times more often in pregnant women with invasive placenta -11 (27.5%). Moderate anemia was present in 4 (22.2%) women in the first group and in 15(37.5%) in the second group. In pregnant women with severe anemia, after 5-7 injections of the drug Sufer significantly increased the level of hemoglobin by 30 g/l, increased the number of erythrocytes to 2.8x1012/l, increased serum iron by 2 times, the level of ferritin increased to 19.6 μg/l and decreased transferrin content. For pregnant women with moderate anemia, 3-5 injections of the drug were sufficient to normalize the indicators. Normalization of blood parameters allowed to reduce the risk of bleeding, and the number of blood transfusions and improved treatment outcomes. Conclusion: Timely diagnosis of iron deficiency anemia in pregnant women with placental pathology is an important means of preventing massive blood loss and reducing the number of blood transfusions, as the first stage of the strategy "patient blood management". Intravenous iron (III) sucrose complex hydroxide (Sufer) has shown high clinical efficacy in the treatment of iron deficiency anemia in pregnant women with placental pathology and can be recommended for widespread use in practical medicine.