Predicting peripartum blood transfusion in women undergoing cesarean delivery: A risk prediction model

Abstract

ObjectiveThere has been an appreciable rise in postpartum hemorrhage requiring blood transfusions in the United States. Our objective is to better define patients at greatest risk for peripartum transfusion at the time of cesarean in order to identify cases for early intervention and monitoring.MethodsOur study is a secondary analysis of a retrospective cohort study. Cases of intraoperative and immediate postpartum blood transfusion among women undergoing cesarean delivery were identified. Multivariable logistic regression models were used to identify antepartum and intrapartum risk factors that were independently associated with blood transfusion. A risk calculator was then developed to predict the need for transfusion.ResultsOf 56,967 women, 1488 (2.6%) required any blood transfusion. The strongest risk factors for peripartum blood transfusion included anemia (odds ratio [OR] 3.7, 95% CI 3.3–4.3), abruption on presentation (OR 3.3, CI 2.6–4.1), general anesthesia (OR 5.2, CI 4.4–6.1) and abnormal placentation (OR 92.0, CI 57.4–147.6). An antepartum (model 1) and combined antepartum plus intrapartum risk model (model 2) were developed (model 1 AUC = 0.77, model 2 AUC = 0.83) and internally validated.ConclusionsAmong women who required cesarean delivery, we were able to identify risk factors which predispose women to peripartum blood transfusion and developed a prediction model with good discrimination.

Blood transfusion and high-order cesarean delivery; Report from a developing country

“…In a large cohort of more than 50,000 women investigators combined the antepartum and intrapartum risk factors for peripartum transfusion 14. Anemia, abruption, general anesthesia and abnormal placentation (OR 92, CI 57.4- 147.6) were identified as the risk factors in this combined model.…”

Predicting risk of postpartum haemorrhage: a systematic review

“…The search strategy identified 2146 citations; following removal of duplicates and screening, 56 full-text articles were assessed for eligibility (PRISMA Flow Diagram, Figure 1). This review included 14 studies [14][15][16][17][18][19][20][21][22][23][24][25][26][27] with a total of 14 final prediction models identified.…”

“…The populations of the included studies are shown in Tables S1 and S2. Five studies 16,18,21,22,27 included only women with placenta praevia, four studies 17,[23][24][25] included only vaginal deliveries, three studies 14,15,20 had a population consisting of CS (planned and unplanned), one study defined population as consisting of women with placenta accreta spectrum 26 and one study 19 had a population encompassing the general obstetric population.…”

“…The setting of the included studies were hospitals in the following countries; Italy, China, France, USA, UK, South Korea, Netherlands, Spain, Zimbabwe, Denmark and Egypt. The study designs included were 11 cohort studies, [14][15][16]18,20,[22][23][24]26,27 of which one used whole population registry data, 21 and three case control studies, 19,25 of which one was nested within a population cohort. 17 The number of participants included in each study ranged from 110 in a prospective cohort study to 56 967 in a retrospective cohort.…”

“…17 The number of participants included in each study ranged from 110 in a prospective cohort study to 56 967 in a retrospective cohort. 14,27 Despite the attempt to predict PPH across all studies, the chosen outcomes differed. Seven studies [17][18][19][20]22,23,26 listed PPH or massive haemorrhage as an outcome, four studies [14][15][16]21 listed blood transfusion or massive blood transfusion as an outcome, two studies 24,25 reported postpartum blood loss and one study 27 had a combined outcome of peripartum complications encompassing perioperative blood transfusion or uterine artery embolisation or caesarean hysterectomy.…”