{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:39:48Z","timestamp":1747183188659,"version":"3.40.5"},"reference-count":13,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T00:00:00Z","timestamp":1558569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We aimed to determine predictive factors for severe hypocalcemia in women with placenta accreta spectrum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Study of 123 women with histology\u2010proven placenta accreta spectrum with cesarean hysterectomy between 2011 and 2017. Two groups were selected: Cases: critically low (\u201cpanic value\u201d) serum total calcium (\u22647\u00a0mg\/dL) and Controls: normal serum total calcium (\u22658.5\u00a0mg\/dL). Regression and receiver operating characteristic (<jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>) analyses were performed to evaluate the potential associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 13\u00a0women with critically low (cases) and 18 with normal calcium (controls).\u00a0Baseline characteristics were not statistically different. The median estimated blood loss, units of red blood cells (<jats:styled-content style=\"fixed-case\">RBC<\/jats:styled-content>s) transfused and volume of crystalloid transfused, were higher in the low calcium group. Six out of 13 (46.2%) cases had received \u22654\u00a0units of <jats:styled-content style=\"fixed-case\">RBC<\/jats:styled-content>s during surgery vs 2 of 18 (11.1%) controls (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.04). <jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content> analysis showed that estimated blood loss, units of <jats:styled-content style=\"fixed-case\">RBC<\/jats:styled-content>s transfused, and crystalloid transfused were associated with severe hypocalcemia and univariate regression analysis confirmed that estimated blood loss \u22651500\u00a0mL, <jats:styled-content style=\"fixed-case\">RBC<\/jats:styled-content> transfusion \u22654 units, and crystalloid transfused \u22654L were associated with severe hypocalcemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Intraoperative transfusion of \u22654 units <jats:styled-content style=\"fixed-case\">RBC<\/jats:styled-content>s is predictive of the development of severe hypocalcemia in placenta accreta spectrum patients experiencing active bleeding. Empiric replacement of 1\u00a0g Ca<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content><jats:sub>2<\/jats:sub> is recommended for every 4\u00a0U <jats:styled-content style=\"fixed-case\">RBC<\/jats:styled-content> transfused.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13636","type":"journal-article","created":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T01:19:10Z","timestamp":1556673550000},"page":"1326-1331","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Severe hypocalcemia during surgery for placenta accreta spectrum: The case for empiric replacement"],"prefix":"10.1111","volume":"98","author":[{"given":"Hadi","family":"Erfani","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6333-3177","authenticated-orcid":false,"given":"Alireza A.","family":"Shamshirsaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin A.","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atefeh","family":"Rezaei","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiu\u2010Ki Rocky","family":"Hui","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir A.","family":"Shamshirsaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed A.","family":"Nassr","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bahram","family":"Salmanian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jimmy","family":"Espinoza","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Teruya","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology Baylor College of Medicine and Texas Children's Hospital Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Belfort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Hospital Houston TX 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