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Kim, Noh, Moon, and Kim: Probability Model of Blood Transfusion for Cesarean Delivery Complicated by Placenta Previa
Original Article

Perinatology 2017;28(2):25-28.

Published online: 19 June 2017

DOI: https://doi.org/10.14734/PN.2017.28.2.25

Probability Model of Blood Transfusion for Cesarean Delivery Complicated by Placenta Previa

Yoon Ha Kim, MD, PhD, Eun Ji Noh, MD, Jong Ho Moon, MD, Jong Woon Kim, MD, PhD

Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea

Correspondence to Yoon Ha Kim, MD, PhD Department of Obstetrics and Gynecology, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6375 Fax: +82-62-227-1637 E-mail: kimyh@jnu.ac.kr

Received 1 November 201612 June 2017       Accepted 15 June 2017

Copyright © 2017 The Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The aim of the study was to identify predictive factors for blood transfusion in women with placenta previa. Also, we construct the equation of probability of blood transfusion with placenta previa.

Methods

We retrospectively reviewed of 388 women with placenta previa who underwent cesarean section between January 2011 to December 2015 at the Department of Obstetrics and Gynecology, Chonnam National University Hospital. We analyzed the relationship between blood transfusion and reproductive risk factors. The statistics were analyzed by Independent t-test, Pearson's chi-square test and Fisher's exact test. Logistic regression was used to assess the relationship between predictive factors and blood transfusion.

Results

Three-hundred and eighty-eight women were selected. 278 (71.6%) women were received blood transfusion intraoperative or after operation. Multiparity, previous cesarean section, placenta previa totalis, low preoperative hemoglobin, adherent placenta, use of tocolytic agent, anterior or anterior and posterior placenta location, history of antepartum hemorrhage, emergency operation, the presence of lacuna were more common in transfusion group.

Conclusion

We concluded that multiparity, previous cesarean section, preoperative hemoglobin, placenta previa totalis, placenta location, and presence of lacuna are the strong antepartum risk factors for peripartum blood transfusion in women with placenta previa. The equation constructed by combining these variables was as follows: probability of blood transfusion in placenta previa= ex/1+ex X=2.731+0.193×Parity+0.343×previous C-sec–0.324×preoperative Hgb+1.477×placenta previa totalis+1.311×ant placenta+1.021×ant & post placenta+1.796×presence of lacuna.

Keywords: Placenta previa, Blood transfusion, Probability

REFERENCES

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Table 1.
Univariate Association with Blood Transfusion
Variables Transfusion P-value
No (n=110) Yes (n=278)
Maternal age (yrs) 33.0 (24-44) 33.0 (22-45) 0.108
Gestational age at birth (wks) 37.0 (27-40) 37 (24-40) 0.001
Parity 0.0 (0-3) 1 (0-5) 0.019
Previous abortion 0.0 (0-9) 0 (0-11) 0.322
Previous cesarean section 0 (0-2) 0 (0-3) 0.010
Preoperative Hgb (g/dL) 11.7 (9.2-15.1) 11.4 (7.1-14.5) <0.001
Estimated blood loss (mL) 890 (500-1,601) 1,186 (425-25,000) <0.001
Multifetal gestation 3 (2.7) 11 (4.0) 0.558
Use of tocolytics 20 (18.2) 94 (33.8) 0.002
Antepartum hemorrhage 36 (32.7) 157 (56.5) <0.001
Uterine myoma 6 (5.5) 23 (8.3) 0.341
Adherent placenta 2 (1.8) 30 (10.8) 0.004
Presence of lacuna 5 (4.5) 64 (23.0) <0.001
Presentation part     0.043
Vertex 99 (90.0) 227 (81.7)  
Others 11 (10.0) 51 (18.3)  
Type of previa     <0.001
Totalis 47 (42.7) 222 (79.9)  
Partialis or marginalis 63 (57.3) 56 (20.1)  
Placenta location     <0.001
Anterior 10 (9.1) 70 (25.2)  
Anterior and posterior 7 (6.4) 61 (21.9)  
Posterior or lateral 93 (84.5) 147 (52.9)  
Type of surgery     <0.001
Elective 88 (80.0) 168 (60.4)  
Emergency 22 (20.0) 110 (39.6)  

Values are presented as number (%) or median (min-max). Abbreviation: Hgb, hemoglobin.

Table 2.
Logistic Regression Results for Predicting Blood Transfusion with Placenta Previa
  β OR 95% CI
Lower Upper
Parity 0.193 1.213 0.836 1.760
Previous C-sec 0.343 1.409 0.728 2.724
Preoperative Hgb -0.324 0.718 0.577 0.892
Type of previa        
Totalis 1.477 4.379 2.537 7.559
Location of placenta        
Anterior 1.311 3.712 1.720 8.010
Ant & post 1.021 2.776 1.114 6.918
Adherent placenta 1.279 3.593 0.775 16.654
Presence of lacuna 1.796 6.023 2.150 16.873
Constant 2.731 15.35    

Abbreviations: CI, confidence interval; OR, odds ratio; C-sec, cesarean section; Hgb, hemoglobin.

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