Prediction Model for Massive Transfusion in Placenta Previa during Cesarean Section

다국어 초록 (Multilingual 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 (Reference)

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