Early administration of intravenous iron at cesarean section

Background. Postpartum anemia remains a global health problem. In most cases, postpartum anemia is associated with antenatal iron deficiency and pathological blood loss during childbirth.

Objective. Evaluation of the efficiency of use of iron isomaltoside in patients with pathological bleeding during cesarean section (CS).

Methods. The study included 77 women who delivered by CS at 35–41 weeks of gestation and developed obstetric bleeding (more than 1000 ml). In the first group (n=42), iron isomaltoside was administered intravenously immediately after CS, regardless of the Hb level, at a dose of 200 mg of iron per volume corresponding to the loss of 1 unit of blood, with a maximum of 2 mg/kg. In the second group (n=35), iron isomaltoside was administered in the postoperative period upon receipt of blood test results and a decrease in the Hb level to less than 90 g/L. Laboratory screening was performed before surgery, in the event of bleeding after restoration of hemostasis, 48 hours after the bleeding. In the presence of clinical manifestations of anemic syndrome (weakness, dizziness), emergency laboratory testing was additionally prescribed.

Results. In patients in the second group, 48 hours after the blood loss, the mean Hb level was 88.7±7.2 g/l, erythrocytes – 2.9±0.8×1012/L, hematocrit – 28.9 ± 4.8%, which was accompanied by clinical manifestations in the form of weakness, dizziness, tachycardia (89.2±5.8 beats/min) and served as the basis for transfusion of erythrocyte suspension in 6 (17.1%) patients. While only 2 (4.8%) patients out of 42 in the first group, who were routinely administered iron isomaltoside, required transfusion of red blood cell suspension, their mean heart rate was determined within 78.1±6.4 beats/min, which was statistically significant (P<0.05).

Conclusion. Early intravenous administration of iron preparations effectively prevents the development of anemia and is associated with a better course of the postoperative period. In patients after obstetric hemorrhage, intravenous administration of iron isomaltoside is recommended at a dose of 200 mg of iron per volume corresponding to the loss of 1 unit of blood, without waiting for a decrease in Hb concentration.