Association of Fibrinogen Use in Cesarean Delivery with Bleeding and Blood Products in Patients with Plasenta Acreata Spectrum: A Retrospective Study

Abstract

Objective: Placenta accreta spectrum (PAS) is a condition with a high risk of perioperative bleeding that can cause maternal morbidity and mortality. Fibrinogen is the first factor of which level decreases in case of perioperative bleeding, although it increases in the last trimester of pregnancy. In this retrospective study, we aimed to evaluate the effect of fibrinogen use on preoperative and postoperative outcomes in PAS patients with high bleeding risk. Material and Methods: In this study, the files of 171 patients who were operated on with the diagnosis of antenatal PAS were examined retrospectively. Patients were divided into two groups according to fibrinogen use. Demographic data of both groups, choice of anesthesia, surgical application, amount of fluid, blood and blood product used peroperatively, amount of bleeding and postoperative complications were evaluated. Results: A total of 146 patients were included in the study. Patients were divided into two groups: group without fibrinogen concentrate (GNF, n=93) and group with fibrinogen concentrate (GF, n=53). The amount of preoperative bleeding, blood utilization and the total amount of fluid given was higher in GF compared to GNF (p<0.05). Postoperative hospital and intensive care unit (ICU) hospitalization history was higher in GF (p<0.05). Conclusion: Fibrinogen concentrate can be used according to the amount of bleeding regardless of the preoperative fibrinogen value in case of bleeding in patients undergoing cesarean section with antenatal PAS. In these patients, anaesthesia management should be determined with a multidisciplinary approach by planning preoperative blood and blood products preparation and ICU according to bleeding and surgical method.