Prediction Model for Massive Transfusion in Placenta Previa during Cesarean Section
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Purpose: Recently, obstetric massive transfusion protocols have shifted toward early intervention. This study aimed to develop aprediction model for transfusion of ≥5 units of packed red blood cells (PRBCs) during cesarean section in women with placentaprevia. Materials and Methods: We conducted a cohort study including 287 women with placenta previa who delivered between September2011 and April 2018. Univariate and multivariate logistic regression analyses were used to test the association between clinicalfactors, ultrasound factors, and massive transfusion. For the external validation set, we obtained data (n=50) from another hospital. Results: We formulated a scoring model for predicting transfusion of ≥5 units of PRBCs, including maternal age, degree of previa,grade of lacunae, presence of a hypoechoic layer, and anterior placentation. For example, total score of 223/260 had a probability of0.7 for massive transfusion. Hosmer-Lemeshow goodness-of-fit test indicated that the model was suitable (p>0.05). The area underthe receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89–0.95]. In external validation,the discrimination was good, with an AUC value of 0.833 (95% CI 0.70–0.92) for this model. Nomogram calibration plots indicatedgood agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observedprobability. Conclusion: We constructed a scoring model for predicting massive transfusion during cesarean section in women with placentaprevia. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timingof blood transfusion.
Abstract
Purpose: Recently, obstetric massive transfusion protocols have shifted toward early intervention. This study aimed to develop aprediction model for transfusion of ≥5 units of packed red blood cells (PRBCs) during cesarean section in women with placentaprevia. Materials and Methods: We conducted a cohort study including 287 women with placenta previa who delivered between September2011 and April 2018. Univariate and multivariate logistic regression analyses were used to test the association between clinicalfactors, ultrasound factors, and massive transfusion. For the external validation set, we obtained data (n=50) from another hospital. Results: We formulated a scoring model for predicting transfusion of ≥5 units of PRBCs, including maternal age, degree of previa,grade of lacunae, presence of a hypoechoic layer, and anterior placentation. For example, total score of 223/260 had a probability of0.7 for massive transfusion. Hosmer-Lemeshow goodness-of-fit test indicated that the model was suitable (p>0.05). The area underthe receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89–0.95]. In external validation,the discrimination was good, with an AUC value of 0.833 (95% CI 0.70–0.92) for this model. Nomogram calibration plots indicatedgood agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observedprobability. Conclusion: We constructed a scoring model for predicting massive transfusion during cesarean section in women with placentaprevia. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timingof blood transfusion.
참고문헌 (39)
- Silver RM, "Abnormal placentation : placenta previa, vasa previa, and placenta accreta", Obstet Gynecol, 126, pp.654~668 (2015)
- Rouse DJ, "Blood transfusion and cesarean delivery", Obstet Gynecol, 108, pp.891~897 (2006)
- Silver RM, "Placenta accreta spectrum", N Engl J Med, 378, pp.1529~1536 (2018)
- Dahlke JD, "Prevention and management of postpartum hemorrhage : a comparison of 4 national guidelines", Am J Obstet Gynecol, 213, pp.76e1~76e10 (2015)
- Weiniger CF, "Anaesthetic management of placenta accreta : use of a pre-operative high and low suspicion classification", Anaesthesia, 60, pp.1079~1084 (2005)
- Mansfield PF, "Complications and failures of subclavian-vein catheterization", N Engl J Med, 331, pp.1735~1738 (1994)
- Snyder CW, "The relationship of blood product ratio to mortality : survival benefit or survival bias", J Trauma, 66, pp.358~362 (2009)
- Pacheco LD, "An update on the use of massive transfusion protocols in obstetrics", Am J Obstet Gynecol, 214, pp.340~344 (2016)
- Finberg HJ, "Placenta accreta : prospective sonographic diagnosis in patients with placenta previa and prior cesarean section", J Ultrasound Med, 11, pp.333~343 (1992)
- Gibbins KJ, "Placenta previa and maternal hemorrhagic morbidity", J Matern Fetal Neonatal Med, 31, pp.494~499 (2018)
- Farquhar CM, "Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand : a case-control study", BMJ Open, 7, pp.e017713~ (2017)
- Baldwin HJ, "Antecedents of abnormally invasive placenta in primiparous women : risk associated with gynecologic procedures", Obstet Gynecol, 131, pp.227~233 (2018)
- Fitzpatrick KE, "Incidence and risk factors for placenta accreta", increta, PLoS One, pp.2012, 7[DOI]
- Getahun D, "Previous cesarean delivery and risks of placenta previa and placental abruption", Obstet Gynecol, 107, pp.771~778 (2006)
- Shamshirsaz AA, "Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta", Obstet Gynecol, 131, pp.234~241 (2018)
- Belfort MA, "Placenta accreta", Am J Obstet Gynecol, 203, pp.430~439 (2010)
- Committee on Obstetric Practice, "Committee opinion no. 529 : placenta accreta", Obstet Gynecol, 120, pp.207~211 (2012)
- Vajiheh Marsoosi, "Development of a scoring system for prediction of placenta accreta and determine the accuracy of its results", The Journal of Maternal-Fetal & Neonatal Medicine, 33(11), pp.1824~1830 (2020), Informa UK Limited[DOI]
- Rac MW, "Ultrasound predictors of placental invasion : the Placenta Accreta Index", Am J Obstet Gynecol, 212, pp.343e1~343e7 (2015)
- Tovbin J, "Prediction of morbidly adherent placenta using a scoring system", Ultrasound Obstet Gynecol, 48, pp.504~510 (2016)
- Guy GP, "Ultrasonographic evaluation of uteroplacental blood flow patterns of abnormally located and adherent placentas", Am J Obstet Gynecol, 163, pp.723~727 (1990)
- Yang JI, "Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section", Ultrasound Obstet Gynecol, 28, pp.178~182 (2006)
- D’Antonio F, "Placenta accreta spectrum disorders : prenatal diagnosis still lacks clinical correlation", Acta Obstet Gynecol Scand, 97, pp.773~775 (2018)
- Pivano A, "A score to predict the risk of emergency caesarean delivery in women with antepartum bleeding and placenta praevia", Eur J Obstet Gynecol Reprod Biol, 195, pp.173~176 (2015)
- Tanimura K, "A novel scoring system for predicting adherent placenta in women with placenta previa", Placenta, 64, pp.27~33 (2018)
- Choi SJ, "Antepartum risk factors associated with peripartum cesarean hysterectomy in women with placenta previa", Am J Perinatol, 25, pp.37~41 (2008)
- Hasegawa J, "Predisposing factors for massive hemorrhage during Cesarean section in patients with placenta previa", Ultrasound Obstet Gynecol, 34, pp.80~84 (2009)
- Lee JY, "Scoring model to predict massive post-partum bleeding in pregnancies with placenta previa : a retrospective cohort study", J Obstet Gynaecol Res, 44, pp.54~60 (2018)
- Bose P, "Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions", BJOG, 113, pp.919~924 (2006)
- Yoon SY, "A combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa", Eur J Obstet Gynecol Reprod Biol, 180, pp.111~115 (2014)
- Kim JW, "Development of a scoring system to predict massive postpartum transfusion in placenta previa totalis", J Anesth, 31, pp.593~600 (2017)
- Ball CG, "Damage control resuscitation : history, theory and technique", Can J Surg, 57, pp.55~60 (2014)
- Holcomb JB, "Damage control resuscitation : directly addressing the early coagulopathy of trauma", J Trauma, 62, pp.307~310 (2007)
- Holcomb JB, "Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients", Ann Surg, 248, pp.447~458 (2008)
- Hess JR, "Damage control resuscitation : the need for specific blood products to treat the coagulopathy of trauma", Transfusion, 46, pp.685~686 (2006)
- Waters JH, "Role of the massive transfusion protocol in the management of haemorrhagic shock", Br J Anaesth, 113(Suppl 2), pp.ii3~ii8 (2014)
- Cunningham FG, "Disseminated intravascular coagulation syndromes in obstetrics", Obstet Gynecol, 126, pp.999~1011 (2015)
- Bleeker SE, "External validation is necessary in prediction research : a clinical example", J Clin Epidemiol, 56, pp.826~832 (2003)
- Leushuis E, "Prediction models in reproductive medicine : a critical appraisal", Hum Reprod Update, 15, pp.537~552 (2009)