Scoring model to predict massive post‐partum bleeding in pregnancies with placenta previa: A retrospective cohort study

Abstract

Aim: We aimed to identify factors associated with massive post-partum bleeding in pregnancies with placenta previa and to establish a scoring model to predict post-partum severe bleeding. Methods: A retrospective cohort study was performed in 506 healthy singleton pregnancies with placenta previa from 2006 to 2016. Cases with intraoperative blood loss (≥2000 mL), packed red blood cells transfusion (≥4), uterine artery embolization, or hysterectomy were defined as massive bleeding. After performing multivariable analysis, using the adjusted odds ratios (aOR), we formulated a scoring model. Results: Seventy-three women experienced massive post-partum bleeding (14.4%). After multivariable analysis, seven variables were associated with massive bleeding: maternal old age (≥35 years; aOR 1.79, 95% confidence interval [CI] 1.00-3.20, P = 0.049), antepartum bleeding (aOR 4.76, 95%CI 2.01-11.02, P < 0.001), non-cephalic presentation (aOR 3.41, 95%CI 1.40-8.30, P = 0.007), complete placenta previa (aOR 1.93, 95% CI 1.05-3.54, P = 0.034), anterior placenta (aOR 2.74, 95%CI 1.54-4.89, P = 0.001), multiple lacunae (≥4; aOR 2.77, 95%CI 1.54-4.99, P = 0.001), and uteroplacental hypervascularity (aOR 4.51, 95%CI 2.30-8.83, P < 0.001). We formulated a scoring model including maternal old age (<35: 0, ≥35: 1), antepartum bleeding (no: 0, yes: 2), fetal non-cephalic presentation (no: 0, yes: 2), placenta previa type (incomplete: 0, complete: 1), placenta location (posterior: 0, anterior: 1), uteroplacental hypervascularity (no: 0, yes: 2), and multiple lacunae (no: 0, yes: 1) to predict post-partum massive bleeding. According to our scoring model, a score of 5/10 had a sensitivity of 81% and a specificity of 77% for predicting massive post-partum bleeding. The area under the receiver-operator curve was 0.856 (P < 0.001). The negative predictive value was 95.9%. Conclusion: Our scoring model might provide useful information for prediction of massive post-partum bleeding in pregnancies with placenta previa.

Nomogram to predict postpartum hemorrhage in cesarean delivery for women with scarred uterus: A retrospective cohort study in China

“…incidence of PPH was greatly reduced after excluding cases with placenta previa or PAS, which is the main reason why DCA of Model B showed a narrow benefit range (1.0-7.0%) and the nonparametric line of calibration plot was short in Model B. Some of the risk factors found in this study have also been reported in other studies, [12][13][14] including age, gravidity, placenta previa, PAS, hypertensive disorders of pregnancy and gestational weeks at delivery, but there are still some differences. First, when dealing with maternal age discretization, we did not adopt the general classification based on the age 35, 20 because age 34 was the best critical value according to the result of optimal discretization analysis.…”

“…Many risk factors associated with PPH have been reported, including maternal age, gravidity, parity, gestational weeks at delivery, neonatal weight, cesarean section, placenta previa, hypertensive disorders of pregnancy, multiple pregnancies. [12][13][14] According to related reports and inclusion criteria of this study, we collected the following information: maternal age, body mass index (BMI) before delivery, gravidity, parity, labor induction times, placental location, placenta previa, placenta accreta spectrum (PAS), hypertensive disorders of pregnancy, gestational diabetes mellitus, fetal position, gestational weeks at delivery, neonatal weight, scarred uterus type, history of other intrauterine surgery, multiple pregnancies, intrauterine fetal demise, PPH. All information was obtained from the hospital electronic database.…”

Letter to ‘Scoring model to predict massive post‐partum bleeding in pregnancies with placenta previa: A retrospective cohort study’: The best scoring model may depend on the situation

“…Dear Editor, We commend Lee et al 1 for proposing a scoring model of massive hemorrhage at placenta previa surgery. Although almost all previous studies attempted to identify the 'odds ratio' of risk factors of massive hemorrhage, we wish to know its 'probability' based on 'combinations' of risk factors: Lee et al showed this.…”

“…To our knowledge, four scoring models, including Lee et al's model, have been proposed. [1][2][3][4] They were constructed in a similar manner: several independent risk factors were determined, which were weighted and incorporated into the model.…”

“…3 Recently, Kim et al 4 proposed another scoring model, in which five factors were employed, with blood transfusion more than 8 units chosen as an endpoint. Here, Lee et al 1 employed seven factors with four endpoints.…”