Is it Possible to Predict Massive Bleeding in Nulliparous Women with Placenta Previa?

Örgül, Gökçen; Ayhan, Şule Göncü; Saracoglu, Gulhan Cetinkaya; Yücel, Aykan

doi:10.1055/s-0040-1721355

Cited by 4 publications

(1 citation statement)

References 23 publications

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“…4 Despite the clinical significance of acute hemorrhage due to its life-threatening characteristics and the need for urgent preparation of massive transfusion to enable optimal management, the development of a prediction model for massive transfusion during surgery is lacking. Several studies have tried to predict massive transfusion during specific types of high-risk procedures, such as liver transplantation, [5][6][7] cardiac surgery, [8][9][10] placenta previa, 11,12 and spine surgery, 13 but the performances of the prediction models were low, with an area under the receiver operating characteristic curve (AUROC) of 0.65 to 0.84. These low predictive powers may originate from the fact that models developed in previous studies were solely based on preoperative factors without incorporating dynamic intraoperative parameters.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

Lee

Kim

et al. 2022

JAMA Netw Open

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ImportanceMassive transfusion is essential to prevent complications during uncontrolled intraoperative hemorrhage. As massive transfusion requires time for blood product preparation and additional medical personnel for a team-based approach, early prediction of massive transfusion is crucial for appropriate management.ObjectiveTo evaluate a real-time prediction model for massive transfusion during surgery based on the incorporation of preoperative data and intraoperative hemodynamic monitoring data.Design, Setting, and ParticipantsThis prognostic study used data sets from patients who underwent surgery with invasive blood pressure monitoring at Seoul National University Hospital (SNUH) from 2016 to 2019 and Boramae Medical Center (BMC) from 2020 to 2021. SNUH represented the development and internal validation data sets (n = 17 986 patients), and BMC represented the external validation data sets (n = 494 patients). Data were analyzed from November 2020 to December 2021.ExposuresA deep learning–based real-time prediction model for massive transfusion.Main Outcomes and MeasuresMassive transfusion was defined as a transfusion of 3 or more units of red blood cells over an hour. A preoperative prediction model for massive transfusion was developed using preoperative variables. Subsequently, a real-time prediction model using preoperative and intraoperative parameters was constructed to predict massive transfusion 10 minutes in advance. A prediction model, the massive transfusion index, calculated the risk of massive transfusion in real time.ResultsAmong 17 986 patients at SNUH (mean [SD] age, 58.65 [14.81] years; 9036 [50.2%] female), 416 patients (2.3%) underwent massive transfusion during the operation (mean [SD] duration of operation, 170.99 [105.03] minutes). The real-time prediction model constructed with the use of preoperative and intraoperative parameters significantly outperformed the preoperative prediction model (area under the receiver characteristic curve [AUROC], 0.972; 95% CI, 0.968-0.976 vs AUROC, 0.824; 95% CI, 0.813-0.834 in the SNUH internal validation data set; P &lt; .001). Patients with the highest massive transfusion index (ie, &gt;90th percentile) had a 47.5-fold increased risk for a massive transfusion compared with those with a lower massive transfusion index (ie, &lt;80th percentile). The real-time prediction model also showed excellent performance in the external validation data set (AUROC of 0.943 [95% CI, 0.919-0.961] in BMC).Conclusions and RelevanceThe findings of this prognostic study suggest that the real-time prediction model for massive transfusion showed high accuracy of prediction performance, enabling early intervention for high-risk patients. It suggests strong confidence in artificial intelligence-assisted clinical decision support systems in the operating field.

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Section: Introductionmentioning

confidence: 99%

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

Lee

Kim

et al. 2022

JAMA Netw Open

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Major Placenta Previa in Advanced Age Among Nulliparous With Cesarean Section: A Cross-Sectional Study

El Sayed,

Labib Elkashif,

Ahmad Elawany

et al. 2023

Int J Childbirth

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INTRODUCTION:Major placenta previa with advanced maternal age (AMA) is a significant risk factor for obstetric hemorrhage and associated maternal and neonatal complications.OBJECTIVE:The objective was to study major placenta previa in advanced age among nulliparous with cesarean section.METHODS:This prospective cross-sectional study analyzes 78 pregnant women of advanced age with major placenta previa under a cesarean section. Data were collected using interview questionnaires between January 2019 and June 2020.RESULTS:The mean gestational age at delivery was 35.7 ± 3 years. Antepartum hemorrhage, premature membrane rupture, and placenta accreta occurred in 15.4%, 35.9%, and 15.4% of cases, respectively. About 12.8% of women were at risk of post-traumatic stress disorder symptoms. Fetal distress, postpartum hemorrhage (PPH), and cesarean hysterectomy occurred in 37.2%, 46.2%, and 15.4% of patients. Mean Apgar scores in the first and fifth minutes were 7.0 ± 0.90 and 8.0 ± 0.82, respectively. The mean birth weight was 2.7 ± 0.14823. Of neonates, 37.2% were premature, 37.2% required resuscitation, less than half (44.9%) were admitted to the neonatal intensive care unit, and 37.2% had respiratory distress syndrome. Moreover, there is a statistically significant relationship between placenta accreta and cesarean hysterectomies and the occurrence of PPH. Also, a highly significant association was observed between the use of antenatal steroids, fetal distress, Apgar score <3 at 1 minute, and neonatal respiratory distress syndrome.CONCLUSION:Major placenta previa with AMA significantly influences pregnancy outcomes and is considered an obstetric emergency. Therefore, early detection of major placenta previa and proper management during clinical care is essential.

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The Feasibility and Safety of Temporary Transcatheter Balloon Occlusion of Bilateral Internal Iliac Arteries during Cesarean Section in a Hybrid Operating Room for Placenta Previa with a High Risk of Massive Hemorrhage

Bae

Kim

et al. 2022

JCM

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This study aimed to evaluate the feasibility and safety of temporary transcatheter balloon occlusion of bilateral internal iliac arteries (TBOIIA) during cesarean section in a hybrid operating room (OR) for placenta previa (PP) with a high risk of massive hemorrhage. This retrospective study analyzed the medical records of 62 patients experiencing PP with a high risk of massive hemorrhage (mean age, 36.2 years; age range 28–45 years) who delivered a baby via planned cesarean section with TBOIIA in a hybrid OR between May 2019 and July 2021. Operation time, estimated blood loss (EBL), amount of intra- and postoperative blood transfusion, perioperative hemoglobin level, hospital stay after operation, balloon time, fluoroscopy time, radiation dose, rate of uterine artery embolization (UAE) and hysterectomy, and complication-related TBOIIA were assessed. The mean operation time was 122 min, and EBL was 1290 mL. Nine out of sixty-two patients (14.5%) received a blood transfusion. The mean hemoglobin levels before surgery, immediately after surgery and within 1 week after surgery were 11.3 g/dL, 10.4 g/dL and 9.2 g/dL, respectively. In terms of radiation dose, the mean dose area product (DAP) and cumulative air kerma were 0.017 Gy/cm2 and 0.023 Gy, respectively. Ten out of sixty-two patients (16.1%) underwent UAE postoperatively in the hybrid OR. One out of sixty-two patients had been diagnosed with placenta percreta with bladder invasion based on preoperative ultrasound, and thus underwent cesarean hysterectomy following TBOIIA and UAE. While intra-arterial balloon catheter placement for managing PP with a high risk of hemorrhage remains controversial, a planned cesarean section with TBOIIA in a hybrid OR is effective in eliminating the potential risk of intra-arterial balloon catheter displacement, thus reducing intraoperative blood loss, ensuring safe placental removal and conserving the uterus.

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Is it Possible to Predict Massive Bleeding in Nulliparous Women with Placenta Previa?

Cited by 4 publications

References 23 publications

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

Major Placenta Previa in Advanced Age Among Nulliparous With Cesarean Section: A Cross-Sectional Study

The Feasibility and Safety of Temporary Transcatheter Balloon Occlusion of Bilateral Internal Iliac Arteries during Cesarean Section in a Hybrid Operating Room for Placenta Previa with a High Risk of Massive Hemorrhage

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