Blood transfusion for caesarean delivery complicated by placenta praevia

Abstract

Gestational age at delivery and type of surgery required are predictors of transfusion during caesarean for placenta praevia. Arterial balloon occlusion does not appear to increase transfusion risk and may be considered as one of the techniques in management.

Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery

“…One study showed that anterior placenta previa was associated with increased risk of excessive blood loss and massive transfusion irrespective of confounding factors [11]. In other studies [12,13], increased risk of hemorrhage in anterior placenta previa was related mainly to the presence of placenta accreta, especially among women with previous cesarean delivery. The main strength of the present study is that it included only women with anterior placenta previa and excluded those with placenta accreta.…”

Associated factors of blood transfusion for Caesarean sections in pure placenta praevia pregnancies

“…The risk factors for blood transfusion were maternal age greater than 34 years, a history of more than one dilatation and curettage, and complete placenta praevia (ORs 3.7, 4.8 and 26, respectively). (10) Subsequently, Boyle et al (11) reported that 71 (34%) of 206 patients with placenta praevia received a blood transfusion during Caesarean section but reported the risk factors to be gestational age of 32-35 weeks at delivery and Caesarean hysterectomy (ORs 2.6 and 29.4, respectively). (11) In these studies, 5.5%-10.6% of the placenta praevia patients also presented with placenta accreta, which may be a confounding factor for massive haemorrhage and the need for a blood transfusion.…”

“…(10) Subsequently, Boyle et al (11) reported that 71 (34%) of 206 patients with placenta praevia received a blood transfusion during Caesarean section but reported the risk factors to be gestational age of 32-35 weeks at delivery and Caesarean hysterectomy (ORs 2.6 and 29.4, respectively). (11) In these studies, 5.5%-10.6% of the placenta praevia patients also presented with placenta accreta, which may be a confounding factor for massive haemorrhage and the need for a blood transfusion. As a result, our transfusion rate in pure placenta praevia pregnancies (19%) was lower than those of the aforementioned studies.…”

“…One study found that the risk factors were advanced maternal age, repeated dilatation and curettage, and complete placenta praevia, (10) while the other study found dissimilar results, delivery at 32-35 weeks of gestation and Caesarean hysterectomy. (11) Most of the previous reports did not exclude cases of placenta accreta from the placenta praevia subjects, analysing them simultaneously. Placenta accreta has been strongly associated with severe maternal morbidity, especially massive intraoperative haemorrhage and the need for blood transfusion, so that it seems to be the important confounding factor.…”

Évaluation du ballon de Bakri dans les hémorragies graves du post-partum et fertilité ultérieure

“…Olsen et al [17] retrouvent également un taux de transfusions conséquent avec un nombre de concentrés globulaires transfusés (4 culots en moyenne) plus élevé que dans notre série. Kavak [24], l'utilisation du BB n'augmente pas le taux de transfusion en cas de césarienne avec placenta praevia.…”