Probability Model of Massive Hemorrhage in Patients with Placenta Previa

Abstract

Objective: The aim of this study was to identify the factors affecting massive hemorrhages in patients with placenta previa. We also made probability models and equations for massive hemorrhage. Methods: Seven hundred and sixty-four patients with placenta previa who underwent cesarean section from January 2011 to September 2019 were retrospectively reviewed. Massive hemorrhage was defined as a blood loss exceeding 1,500 mL or receiving over four units of packed red blood cells during cesarean section. Logistic regression analysis was used to create a probability model and identify the predictive factors for massive hemorrhage. Results: Two hundred and seventy-three (35.7%) patients had massive hemorrhages. Preoperative hemoglobin levels, multifetal gestation, emergent surgery, history of a previous cesarean section, location of the placenta, the presence of lacuna, placental adhesion, the type of placenta previa, and multiparity were selected predictive factors for massive hemorrhage. One hundred seventy-eight (23.3%) patients had placenta previa and a history of previous cesarean section. Among them, massive hemorrhage occurred in 101 (56.7%). The selected predictive factors for massive hemorrhage in patients with placenta previa and a history of previous cesarean section were emergent surgery, location of the placenta, the presence of lacuna, placental adhesion, and preoperative hemoglobin levels. An equation for massive hemorrhage in patients with placenta previa was created by combining variables. Conclusion: An equation for massive hemorrhage in patients with placenta previa was created by combining variables. These equations may help in managing placenta previa patients with high risk.