Prediction Model for Massive Transfusion in Placenta Previa during Cesarean Section

• Published in: Yonsei medical journal Vol. 61; no. 2; pp. 154 - 160
• Main Authors: Kang, Jieun, Kim, Hye Sim, Lee, Eun Bi, Uh, Young, Han, Kyoung Hee, Park, Eun Young, Lee, Hyang Ah, Kang, Dae Ryong, Chung, In Bai, Choi, Seong Jin
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.02.2020; 연세대학교의과대학
• Subjects: Adult; Blood Transfusion; Calibration; Cesarean Section; Female; Humans; Logistic Models; Maternal Age; Models, Biological; Multivariate Analysis; Nomograms; Original; Placenta Previa - therapy; Pregnancy; Probability; Retrospective Studies; ROC Curve; Young Adult; 의학일반; postpartum hemorrhage; cesarean section; prediction model; Blood transfusion; placenta previa
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2020.61.2.154

Recently, obstetric massive transfusion protocols have shifted toward early intervention. This study aimed to develop a prediction model for transfusion of ≥5 units of packed red blood cells (PRBCs) during cesarean section in women with placenta previa. We conducted a cohort study including 287 women with placenta previa who delivered between September 2011 and April 2018. Univariate and multivariate logistic regression analyses were used to test the association between clinical factors, ultrasound factors, and massive transfusion. For the external validation set, we obtained data (n=50) from another hospital. 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 of 0.7 for massive transfusion. Hosmer-Lemeshow goodness-of-fit test indicated that the model was suitable ( >0.05). The area under the 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 indicated good agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observed probability. We constructed a scoring model for predicting massive transfusion during cesarean section in women with placenta previa. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timing of blood transfusion.