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Prediction Model for Massive Transfusion in Placenta Previa during Cesarean Section

Yonsei Medical Journal 2020년 61권 2호 p.154 ~ 160
강지은 ( Kang Ji-Eun ) - Yonsei University Wonju College of Medicine Department of Obstetrics and Gynecology

김혜심 ( Kim Hye-Sim ) - Yonsei University Wonju College of Medicine Center of Biomedical Data Science
이은비 ( Lee Eun-Bi ) - Yonsei University Wonju College of Medicine Department of Anesthesiology and Pain Medicine
어영 ( Uh Young ) - Yonsei University Wonju College of Medicine Department of Laboratory Medicine
한경희 ( Han Kyoung-Hee ) - Yonsei University Wonju College of Medicine Department of Obstetrics and Gynecology
박은영 ( Park Eun-Young ) - Yonsei University Wonju College of Medicine Department of Obstetrics and Gynecology
이향아 ( Lee Hyang-Ah ) - Kangwon National University School of Medicine Department of Obstetrics and Gynecology
강대룡 ( Kang Dae-Ryong ) - Yonsei University Wonju College of Medicine Department of Precision Medicine and Biostatistics
정인배 ( Chung In-Bai ) - Yonsei University Wonju College of Medicine Department of Obstetrics and Gynecology
최성진 ( Choi Seong-Jin ) - Yonsei University Wonju College of Medicine Department of Obstetrics and Gynecology

Abstract


Purpose: Recently, obstetric massive transfusion protocols have shifted toward early intervention. This study aimed to develop a prediction model for transfusion of ≥5 units of packed red blood cells (PRBCs) during cesarean section in women with placenta previa.

Materials and Methods: We conducted a cohort study including 287 women with placenta previa who delivered between September 2011 and April 2018. Univariate and multivariate logistic regression analyses were used to test the association between clinical factors, ultrasound factors, and massive transfusion. For the external validation set, we obtained data (n=50) from another hospital.

Results: We formulated a scoring model for predicting transfusion of ≥5 units of PRBCs, including maternal age, degree of previa, grade of lacunae, presence of a hypoechoic layer, and anterior placentation. For example, total score of 223/260 had a probability of 0.7 for massive transfusion. Hosmer-Lemeshow goodness-of-fit test indicated that the model was suitable (p>0.05). The area under the receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89?0.95]. In external validation, the discrimination was good, with an AUC value of 0.833 (95% CI 0.70?0.92) for this model. Nomogram calibration plots indicated good agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observed probability.

Conclusion: We constructed a scoring model for predicting massive transfusion during cesarean section in women with placenta previa. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timing of blood transfusion.

키워드

Blood transfusion; cesarean section; placenta previa; postpartum hemorrhage; prediction model
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