Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum

Abstract

To evaluate red blood cell use during delivery in patients with placenta accreta spectrum.DATA SOURCES: We searched MEDLINE, EMBASE, CI-NAHL, Cochrane Central, ClinicalTrials.gov, and Scopus for clinical trials and observational studies published between 2000 and 2021 in countries with developed economies.METHODS OF STUDY SELECTION: Abstracts (n54,275) and full-text studies (n5599) were identified and reviewed by two independent reviewers. Data on transfused red blood cells were included from studies reporting means and SDs, medians with interquartile ranges, or individual patient data. The primary outcome was the weighted mean number of units of red blood cells transfused per patient. Between-study heterogeneity was assessed with an I 2 statistic. Secondary analyses included red blood cell usage by placenta accreta subtype. TABULATION, INTEGRATION, AND RESULTS:Of the 599 full-text studies identified, 20 met criteria for inclusion in the systematic review, comprising 1,091 cases of placenta accreta spectrum. The number of units of red blood cells transfused was inconsistently described across studies, with five studies (25.0%) reporting means, 11 (55.0%) reporting medians, and four (20.0%) reporting individual patient data. The weighted mean number of units transfused was 5.19 (95% CI 4.12-6.26) per patient. Heterogeneity was high across studies (I 2 591%). In a sensitivity analysis of five studies reporting mean data, the mean number of units transfused was 6.61 (95% CI 4.73-8.48; n5220 patients). Further quantification of units transfused by placenta accreta subtype was limited due to methodologic inconsistencies between studies and small cohort sizes.CONCLUSION: Based on the upper limit of the CI in our main analysis and the high study heterogeneity, we recommend that a minimum of 6 units of red blood cells be available before delivery for patients with placenta accreta spectrum. These findings may inform future guidelines for predelivery blood ordering and transfusion support.

Case report of pregnancy complicated by severe pulmonary hypertension from mitral stenosis and placenta accreta spectrum disorder: management of two life-threatening conditions

“… 4 Transfusion at the time of delivery is reported in up to 50% of patients. 5 , 6 The presence of PASD in addition to severe pulmonary hypertension in this case greatly impacted clinical decision-making, particularly the need for hysterectomy before valvular surgery.…”

Caesarean scar pregnancy. Analysis of medical intragestational therapy in a cohort of 35 patients

“…According to data from a systematic review published in 2013, the average number of units of packed red blood cells transfused per patient during the perioperative period is 5, with some women receiving more than 100 units of packed red blood cells. Additionally, intraoperative urinary tract injuries occur in up to one-third of patients, with a median operation time of 5 h [8,9]. In cases of unexpected intraoperative finding of PAS in an unprepared centre, the mortality rate reached 22%, and the rate of intensive care unit hospitalization was 85% [10].…”

Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

“…Median blood loss during delivery in women diagnosed with PAS is estimated to be 3000 mL [7]. In addition, >90.0% of all 2 of 13 women with PAS receive red blood cell (RBC) transfusion during childbirth [8,9]. Planned caesarean hysterectomy (HE) at the time of the delivery is the standard of care [10].…”