Abdominal Ultrasound Assessment in the Post-cesarean Patient
Condition: Postpartum Hemorrhage; Postsurgical Bleeding; Abdominal Ultrasound; FAST Scan; Non-invasive Hemoglobin Measurement
MeSH terms: Postpartum Hemorrhage; Hemorrhage
Study type: Observational

Summary: 
      This study is designed to see if abdominal ultrasound after planned cesarean delivery can
      identify women with ongoing intra-abdominal bleeding.
    

Detailed description: 
      Hemorrhage is the second leading cause of maternal mortality in the United States. Women have
      an increased risk of hemorrhage after cesarean sections.Uterine atony is the culprit in 80%
      of cases, but in the post-operative patient, an intra-abdominal bleed requiring a return to
      the operating room must also be considered. The Focused Assessment with Sonography in Trauma
      (FAST) has been used in the emergency department to evaluate for intra-abdominal bleeding
      after trauma. FAST evaluation has not been studied in the post-operative period for
      evaluation for intra-abdominal bleeding. Ultrasound is a rapid and readily-available modality
      for this type of evaluation, and obstetricians are already familiar with the technology. But
      one must be cautious, as a certain amount of free fluid on CT is common in the postoperative
      patient. Before basing clinical decisions on a FAST scan, we much determine how much fluid is
      normal in a patient after cesarean delivery. We hypothesize that a certain amount of fluid in
      the abdomen visualized by ultrasound may be normal after a cesarean delivery, and that for
      ultrasound to become a valuable modality to assess for intra-abdominal bleeding in the
      post-cesarean patient, the amount of normal fluid must be determined. However, in order to
      interpret what an "appropriate" amount of fluid would be, we will also need an assessment of
      patient hemoglobin levels. Thus, we would additionally plan to validate a rapid, non-invasive
      hemoglobin measurement for use in the post-cesarean obstetric patient. The Pronto7 device
      measures the blood's absorption of multiple wavelengths of light to determine hemoglobin. The
      device avoids a blood draw and its associated pain. It also provides immediate results. We
      anticipate that we will identify an association between the amount of fluid seen on
      ultrasonographic evaluation after cesarean delivery and adverse outcomes such as larger than
      expected decrease in hemoglobin, need for transfusion and need for take-back to the operating
      room. We also anticipate that the use of non-invasive hemoglobin measurements may provide a
      rapid, painless assessment of postoperative hemoglobin; this may allow us to identify
      patients who merit earlier postoperative monitoring with a traditional CBC. It may also allow
      us to identify women who do not need an invasive CBC on postoperative day 1, which may
      decrease blood draws and costs in the future.
    

Intervention name(s): FAST scan and non-invasive hemoglobin measurement
Intervention type(s): Device
Intervention description(s): A "FAST scan", or abdominal ultrasound will be performed within one hour of cesarean delivery to establish normal levels of postoperative intraabdominal fluid.
Women will also have their hemoglobin measured via a non-invasive method, the Masimo Pronto 7, at 3 time points: immediately prior to surgery (within 2 hours), immediately after surgery (within 1 hour), and the morning following surgery (within 24 hours).
Other intervention name(s): Masimo Pronto 7; FAST scan
Intervention MeSH terms: Chrysarobin
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Women undergoing non-emergent cesarean delivery at Prentice Women's Hospital, who speak
        English and are able to provide consent, will be eligible to participate.
      
Keywords: postpartum hemorrhage; postsurgical bleeding; abdominal ultrasound; FAST scan; non-invasive hemoglobin measurement