Impact of “natural” cesarean delivery on peripartum blood loss: A
randomized controlled trial
Abstract
Objective: To examine the impact of “natural” cesarean deliveries
(NCD) on peripartum maternal blood loss. Design: Randomized controlled
trial. Setting: Single academic hospital in Afula, Israel, between
August 2016 and February 2019. Population or Sample: Term singleton
gestations scheduled for a planned CD under spinal anesthesia. Methods:
Women were randomized at a ratio of 1:1 to NCD (study group) or
traditional CD (control group). Women in the study group watched fetal
extraction, had early skin to skin contact, and breastfed until the end
of surgery. Neonates in the control group were presented to the mother
without direct contact. Blood samples were drawn from all women to
determine oxytocin levels using an ELISA kit. Main Outcome Measures:
Postpartum hemoglobin (Hb) levels. Results: 214 women randomized, 23
were excluded. There were no significant differences in demographic and
obstetric variables between the groups. Postpartum Hb levels were
10.1±1.1 and 10.3±1.3 g/dL in the study and control groups, respectively
(P = .19). There were no significant differences in estimated blood
loss, and rates of PPH and blood transfusion. Maternal pain scores,
satisfaction, and exclusive breastfeeding rate at discharge, were
similar. Maternal oxytocin blood levels were 389.5±183.7 and 408.5±233.6
pg/mL in the study and control groups, respectively (P = .96). Rate of
composite neonatal morbidity that comprised neonatal hypothermia,
hypoglycemia, jaundice, and neonatal intensive care unit admission was
higher in the study group. Conclusions: NCD does not affect maternal
blood loss. Maternal oxytocin blood levels in NCD and traditional CD are
similar.