Predictors of Massive Blood Loss in Women With Placenta Accreta

Abstract

O bstetric hemorrhage is the cause of 10% of maternal deaths in the United States, and occurs in more than 600,000 women a year. One of the most common causes of obstetric hemorrhage is abnormal placentation. Past cesarean deliveries directly increase the risk of placenta accreta. Peripartum hysterectomy is often the treatment for placenta accreta but is associated with morbidity and requires large quantities of blood products in a small time span. The goal of this study was to establish predictors of massive blood loss in patients with placenta accreta who went on to hysterectomy. The authors identified the factors associated with large-volume blood component transfusion to create referral recommendations for women with abnormal placentation.The authors did a retrospective study of women with pathologically confirmed placenta accreta (including placenta increta and percreta) who delivered between 2000 and 2010. Preoperative, intraoperative, and postoperative factors of each delivery were reviewed and imaging results were gathered. The authors considered loss of the endometrial-myometrial interface, invasion in to the myometrium or surrounding tissues or the presence of lacunar spaces within the placenta to be verification of abnormal placentation. Estimated blood loss (EBL) was taken from operative reports, and the number of units of packed red blood cells (PRBCs) given during surgery was determined. The primary endpoints of the study were massive blood loss, defined as Z5000 mL, and large-volume PRBC transfusion, defined as Z10 units of red cells. Multivariable logistic regression models were used to study predictors of the primary endpoints with a statistically significant probability value of <0.05.Seventy-seven patients met the criteria. At the time of delivery, 68 women (88.3%) had a hysterectomy, 44 women (57.1%) were Z35 years old, and 19 women (24.7%) were Z37 weeks pregnant. Thirty-nine women (50.6%) chose elective delivery; 72.7% of the patients had a placenta previa. Fifty-two women (67.5%) had placenta accreta and 25 women (32.5%) had placenta increta or percreta.The median EBL was 3000 mL; it was r2500 mL in 31 patients (40.3%). Sixty (60) women (77.9%) had an EBL of r5000 mL. Ten women (13.0%) experienced blood loss of more than 10,000 mL. The mean transfusion requirement was 5 units of PRBCs; 34 women (44.2%) needed <5 units, 52 women (67.5%) needed <10 units, and 60 women (77.9%) needed <15 units. Twelve patients (15.6%) received Z20 units, and 6 patients (7.8%) needed Z30 units of PRBCs. Among women diagnosed antenatally with abnormal placentation, 41.7%, had an EBL of Z5000 mL compared with 12% who were not diagnosed antenatally (P = 0.01). Patients treated more recently had a higher chance of heavy bleeding; 41.9% of women who delivered between 2006 and 2010 had an EBL of Z5000 mL versus only 17.7% of women who delivered between 2000 and 2005 (P = 0.02). Massive blood loss occurred in 26.9% of patients with placenta accreta and in 40.0% of patients with placenta increta or placenta percreta (P...

Accuracy of three-dimensional multislice view Doppler in diagnosis of morbid adherent placenta

“…In this study, parity and the number of previous cesarean sections were significantly high among women who had difficult placental delivery, considerable intraoperative blood loss, who required emergency hysterectomy to control bleeding. Wright et al (29) found that 41.7% of women with a known placenta accreta had a blood loss of ≥5000 mL, and, although Wright et al (29) concluded that there was no significant relation between parity, number of previous cesarean deliveries, degree of placental invasion, and massive blood loss, Tikkanen et al (30) found that the risk factors of placenta accreta included parity, cesarean section, and placenta previa. In addition, Guleria et al (31) concluded that the risk factors of abnormal invasive placentation (AIP) were placenta previa and a past history of cesarean delivery, and Thia et al (32) concluded that the depth of invasion in MAP is increased with multiple previous surgeries or excessive curettage or infection causing defective decidua basalis.…”

The Use of Modified Triple-P Method with Adherent Placenta Long - Term Results

“…[2][3][4] During caesarean section the volume of blood loss in placenta accreta is so great that it often exceeds several times the total blood volume of the patient. [5][6][7] On the background of previously submitted data about a huge amount of blood loss in placenta accreta appear unique results presented by the English authors, which report about the development and implementation of their own new interdisciplinary methods, called "Triple-P". When using this method, the average intraoperative blood loss was 1440ml (ranges from 800ml to 2,900ml).…”

Histerectomía obstétrica en el Hospital General Dr. Aurelio Valdivieso, Oaxaca, México

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