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

Blood Transfusion Predictors in Cesarean Sections for Pregnancies With Placenta Accreta and Placenta Previa: A Monocentric Tertiary Experience

Objective The objective of this study was to analyze the possible predictors of the need for intraoperative blood transfusion in cesarean sections for pregnancies with abnormal placentation. Methods This was a retrospective study based on data from patients' electronic medical records. A total of 44 patients who were diagnosed as placenta previa or placenta accreta who delivered through cesarean section at King Fahad University Hospital, Al-Khobar, Saudi Arabia, from June 1997 to January 2021 were included in the study. Seventeen patients received intra-operative blood transfusion. The other 27 patients did not receive any blood transfusions and served as controls. Demographic data, antepartum profiles, and obstetric history were compared between the two groups. Univariate analysis and multivariate logistic regression were used to analyze the correlations between related risk factors and the need for intraoperative blood transfusion. Results Univariate analysis (χ2 test) has shown multiple factors that correlated significantly (p<0.05) with blood transfusion requirement. These factors include the presence of placenta accreta, general anesthesia, preoperative hematocrit < 33%, preoperative hemoglobin ≤ 10 g/dL, and preterm delivery at 35-36 weeks of gestation. None of these factors showed any statistical significance in multivariate analysis (logistic regression). Conclusion General anesthesia, placenta accreta, delivery at 35-36 weeks of gestation, and pre-operative anemia are possible risk factors for blood transfusion during cesarean sections for abnormal placentation. Identifying patients at increased risk is necessary to optimize pre-operative and intraoperative management.

Effect of previous placenta previa on outcome of next pregnancy: a 10-year retrospective cohort study

BACKGROUND

To determine the effects of previous placenta previa on the maternal and neonatal outcomes of the next pregnancy.

METHODS

This 10-year retrospective cohort study was conducted in the Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, between January 2009 and 2018. We retrospectively analyzed the effects of a previous singleton pregnancy in women with and without placenta previa on the outcomes of the subsequent pregnancy. To control for confounders, we used multiple logistic regression models.

RESULTS

A total of 57,251 women with singleton pregnancies gave birth during the 10-year study period. Among them, 6070 women had two consecutive births. For the first pregnancy, 1603 women delivered by cesarean delivery and 4467 by vaginal delivery. Among women with a history of cesarean delivery, placenta previa was an independent risk factor for hemorrhage (adjusted odds ratio [aOR]: 2.25, 95% confidence interval [CI]: 1.1-4.62), placenta accreta spectrum (PAS) disorders (aOR: 4.11, 95% CI: 1.68-10.06), and placenta previa (aOR: 6.24, 95% CI: 2.85-13.67) during the subsequent pregnancy. Puerperal infection, blood transfusion, and perinatal outcomes did not significantly differ between women with a history of placenta previa and women without this history. Among women with a history of vaginal delivery, placenta previa increased the risk of PAS disorders (aOR: 5.71, 95% CI: 1.81-18.03) and placenta previa (aOR: 4.14, 95% CI: 1.07-16.04) during the subsequent pregnancy. There was no significant difference between the two groups in terms of hemorrhage, blood transfusion, puerperal infection, and perinatal outcomes.

CONCLUSIONS

Women with a history of placenta previa are at risk for adverse outcomes such as postpartum hemorrhage, PAS disorders, and placenta previa in the subsequent pregnancy.