Severe hypocalcemia during surgery for placenta accreta spectrum: The case for empiric replacement

Abstract

Introduction We aimed to determine predictive factors for severe hypocalcemia in women with placenta accreta spectrum. Material and methods Study of 123 women with histology‐proven placenta accreta spectrum with cesarean hysterectomy between 2011 and 2017. Two groups were selected: Cases: critically low (“panic value”) serum total calcium (≤7 mg/dL) and Controls: normal serum total calcium (≥8.5 mg/dL). Regression and receiver operating characteristic (ROC) analyses were performed to evaluate the potential associations. Results There were 13 women with critically low (cases) and 18 with normal calcium (controls). Baseline characteristics were not statistically different. The median estimated blood loss, units of red blood cells (RBCs) transfused and volume of crystalloid transfused, were higher in the low calcium group. Six out of 13 (46.2%) cases had received ≥4 units of RBCs during surgery vs 2 of 18 (11.1%) controls (P = 0.04). ROC analysis showed that estimated blood loss, units of RBCs transfused, and crystalloid transfused were associated with severe hypocalcemia and univariate regression analysis confirmed that estimated blood loss ≥1500 mL, RBC transfusion ≥4 units, and crystalloid transfused ≥4L were associated with severe hypocalcemia. Conclusions Intraoperative transfusion of ≥4 units RBCs is predictive of the development of severe hypocalcemia in placenta accreta spectrum patients experiencing active bleeding. Empiric replacement of 1 g CaCL2 is recommended for every 4 U RBC transfused.

Magnesium sulfate titration reduces maternal complications following fetoscopic closure of spina bifida

“…The sonographic criteria suggestive of atelectasis used included “lung volume loss” with displacement of adjacent structures 11 . Hypocalcemia was defined as serum total calcium measurement ≤7 mg/dl or ≤1.75 mmol/L 13 …”

Preventing severe hypocalcemia during surgery for placenta accreta spectrum

“…Levin and Rottenstreich and Drs. Matsubara et al for their letters about our recently published research article . We are happy to address their concerns:…”

Volume of packed red blood cells and fresh frozen plasma is associated with intraoperative hypocalcaemia during large volume intraoperative transfusion

“…7 Differences in clinical significance between the trauma and perioperative populations are hypothesised to result from alterations in citrate clearance secondary to hypotension, acidosis, and hypothermia in the trauma cohort. 6 Recent studies on intraoperative and perioperative massive resuscitation have been limited to specific surgeries, such as abdominal aortic aneurysm, 8 placenta accreta, 9 or liver transplantation, 10 which may not be widely generalizable. The largest study in non-cardiac surgery patients found that transfusion with 5 or more units of red blood cells was associated with increased 30-day mortality and greater rate of postoperative complications, however, this study did not specifically characterise the incidence and risk factors for abnormalities, like hypocalcaemia, in the massive transfusion population.…”