DOI QR코드

DOI QR Code

Risk factors for blood transfusion after Cesarean section in patients with partial placenta previa

  • Hyun Jung Kim (Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine) ;
  • Woo Hee Lim (Department of Anesthesiology and Pain Medicine, Jeju National University Hospital) ;
  • Young Sun Kim (Department of Anesthesiology and Pain Medicine, Asan Medical Center)
  • Received : 2023.08.31
  • Accepted : 2023.10.16
  • Published : 2023.12.31

Abstract

This study assessed risk factors for blood transfusion after Cesarean section in patients with partial placenta previa. We retrospectively reviewed the medical records of 149 patients who underwent Cesarean sections for partial placenta previa between January 2010 and October 2021. Clinical characteristics were compared between the two groups: the blood transfusion group (n=22), defined as patients who received a blood transfusion during surgery or within 24 hours after surgery, and the non-blood transfusion group (n=127), which included other patients. Multivariable logistic regression analysis identified two risk factors independently associated with blood transfusion: antenatal hemorrhage (adjusted odds ratio [aOR], 16.283; 95% confidence interval [CI], 4.405-60.190; P<0.001) and preoperative hemoglobin (g/dL) (aOR, 0.427; 95% CI, 0.246-0.739; P=0.002). Thus, patients who are at risk for these two factors should be carefully managed with sufficient preparation for blood transfusion and anesthetic management.

Keywords

Acknowledgement

This work was supported by the 2023 education, research and student guidance grant funded by Jeju National University.

References

  1. Butwick AJ, Ramachandran B, Hegde P, Riley ET, El-Sayed YY, Nelson LM. Risk factors for severe postpartum hemorrhage after Cesarean delivery: case-control studies. Anesth Analg 2017;125:523-32.  https://doi.org/10.1213/ANE.0000000000001962
  2. Lal AK, Hibbard JU. Placenta previa: an outcome-based cohort study in a contemporary obstetric population. Arch Gynecol Obstet 2015;292:299-305.  https://doi.org/10.1007/s00404-015-3628-y
  3. Crane JM, Van den Hof MC, Dodds L, Armson BA, Liston R. Maternal complications with placenta previa. Am J Perinatol 2000;17:101-5.  https://doi.org/10.1055/s-2000-9269
  4. Tuzovic L. Complete versus incomplete placenta previa and obstetric outcome. Int J Gynaecol Obstet 2006;93:110-7.  https://doi.org/10.1016/j.ijgo.2006.02.006
  5. Sekiguchi A, Nakai A, Kawabata I, Hayashi M, Takeshita T. Type and location of placenta previa affect preterm delivery risk related to antepartum hemorrhage. Int J Med Sci 2013;10:1683-8.  https://doi.org/10.7150/ijms.6416
  6. Hasegawa J, Matsuoka R, Ichizuka K, Mimura T, Sekizawa A, Farina A, et al. Predisposing factors for massive hemorrhage during Cesarean section in patients with placenta previa. Ultrasound Obstet Gynecol 2009;34:80-4.  https://doi.org/10.1002/uog.6426
  7. Baba Y, Matsubara S, Ohkuchi A, Usui R, Kuwata T, Suzuki H, et al. Anterior placentation as a risk factor for massive hemorrhage during cesarean section in patients with placenta previa. J Obstet Gynaecol Res 2014;40:1243-8.  https://doi.org/10.1111/jog.12340
  8. Jing L, Wei G, Mengfan S, Yanyan H. Effect of site of placentation on pregnancy outcomes in patients with placenta previa. PLoS One 2018;13:e0200252. 
  9. Na C, Kim HJ. Body mass index and massive hemorrhage after Cesarean section in patients with placenta previa. J Med Life Sci 2022;19:39-45.  https://doi.org/10.22730/jmls.2022.19.2.39
  10. Jang DG, We JS, Shin JU, Choi YJ, Ko HS, Park IY, et al. Maternal outcomes according to placental position in placental previa. Int J Med Sci 2011;8:439-44.  https://doi.org/10.7150/ijms.8.439
  11. Park HS, Cho HS. Management of massive hemorrhage in pregnant women with placenta previa. Anesth Pain Med (Seoul) 2020;15:409-16.  https://doi.org/10.17085/apm.20076
  12. Ogoyama M, Takahashi H, Baba Y, Yamamoto H, Horie K, Nagayama S, et al. Bleeding-related outcomes of low-risk total placenta previa are equivalent to those of partial/marginal placenta previa. Taiwan J Obstet Gynecol 2022;61:447-52.  https://doi.org/10.1016/j.tjog.2022.03.007
  13. Oya A, Nakai A, Miyake H, Kawabata I, Takeshita T. Risk factors for peripartum blood transfusion in women with placenta previa: a retrospective analysis. J Nippon Med Sch 2008;75:146-51.  https://doi.org/10.1272/jnms.75.146
  14. Boyle RK, Waters BA, O'Rourke PK. Measures of blood loss and red cell transfusion targets for caesarean delivery complicated by placenta praevia. Aust N Z J Obstet Gynaecol 2010;50:242-5.  https://doi.org/10.1111/j.1479-828X.2010.01163.x
  15. Kang J, Kim HS, Lee EB, Uh Y, Han KH, Park EY, et al. Prediction model for massive transfusion in placenta previa during Cesarean section. Yonsei Med J 2020;61:154-60.  https://doi.org/10.3349/ymj.2020.61.2.154
  16. Lee HJ, Lee YJ, Ahn EH, Kim HC, Jung SH, Chang SW, et al. Risk factors for massive postpartum bleeding in pregnancies in which incomplete placenta previa are located on the posterior uterine wall. Obstet Gynecol Sci 2017;60:520-6.  https://doi.org/10.5468/ogs.2017.60.6.520
  17. Hasegawa J, Nakamura M, Hamada S, Matsuoka R, Ichizuka K, Sekizawa A, et al. Prediction of hemorrhage in placenta previa. Taiwan J Obstet Gynecol 2012;51:3-6.  https://doi.org/10.1016/j.tjog.2012.01.002
  18. Bhide A, Thilaganathan B. Recent advances in the management of placenta previa. Curr Opin Obstet Gynecol 2004;16:447-51.  https://doi.org/10.1097/00001703-200412000-00002
  19. Chang CC, Wang IT, Chen YH, Lin HC. Anesthetic management as a risk factor for postpartum hemorrhage after cesarean deliveries. Am J Obstet Gynecol 2011;205:462.e1-7.  https://doi.org/10.1016/j.ajog.2011.06.068
  20. Hong JY, Jee YS, Yoon HJ, Kim SM. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome. Int J Obstet Anesth 2003;12:12-6. https://doi.org/10.1016/S0959-289X(02)00183-8