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Predictive Model for Massive Blood Transfusion during Cesarean Section of Placenta Previa |
ZHOU Fen-he, PU Chi, BA Sang |
The first maternal and Child Health Hospital Affiliated to Tongji University, Shanghai, 201204 |
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Abstract 【Objective】To establish a predictive model for MT (massive transfusion) during cesarean section of placenta previa (PP). 【Methods】The medical records of PP patients who underwent cesarean section in our hospital from January 2016 to June 2020 were analyzed. According to the occurrence of massive intraoperative blood transfusion (MT), patients were divided into the MT group (infusion ≥ 5 units of packed red blood cells) and the non MT group (NMT, infusion <4 units of PRBC). Relationship between clinical factors and intraoperative massive blood transfusion was examined by univariate and multivariate logistic analysis. Single factor and multivariate logistic analysis were used to analyze the risk factors of intraoperative MT, the results of multivariate logistic analysis were used to draw up the intraoperative MT risk factor (MTR), and the receiver operating curve (ROC) was used to analyze the area under curve (AUC) that predicted MT with MTR and single risk factor. 【Results】There were significant differences between the MT group and the NMT group in preposition, history of miscarriage, placental lacuna, hypoechoic layer loss, and anterior placenta ( P <0.05).Binary multivariate logistic analysis showed that complete placenta previa, hypoechoic layer loss and anterior placenta were independent risk factors of NMT ( P <0.05). The MTR formula was MTR = 2.437 × (complete placenta previa) + 4.382 × (hypoechoic layer loss) + 1.167 × (anterior placenta). ROC curve showed that the AUC of MTR score predicting intraoperative MT was 0.918, which was higher than that of complete placenta previa (0.787), hypoechoic layer loss (0.718) and anterior placenta (0.717) ( Z =3.785, 5.266, 4.298, P <0.001). 【Conclusion】This study established the prediction model of MT during cesarean section in PP patients by multivariate logistic analysis. Clinicians can predict the risk of MT during cesarean section according to MT risk score, and prepare for massive blood transfusion in the early stage.
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Received: 12 November 2020
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