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Scoring model to predict massive post‐partum bleeding in pregnancies with placenta previa: A retrospective cohort study
Author(s) -
Lee Ji Yeon,
Ahn Eun Hee,
Kang Sukho,
Moon Myung Jin,
Jung Sang Hee,
Chang Sung Woon,
Cho Hee Young
Publication year - 2018
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.13480
Subject(s) - medicine , placenta previa , obstetrics , retrospective cohort study , odds ratio , antepartum hemorrhage , placenta , placenta accreta , confidence interval , pregnancy , hysterectomy , blood transfusion , gynecology , fetus , surgery , genetics , biology
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.