Proteinuria as a novel risk factor for allogeneic blood transfusion irrespective of single or twin pregnancy

Hiromitsu Takahashi ,Kenji Horie ,Akihide Ohkuchi ,Shogo Nagayama ,Ryuichi Usui ,Yoshinobu Baba ,Shigeki Matsubara

doi:10.31083/j.ceog.2020.05.5315

Abstract

Objective: To clarify whether isolated proteinuria (IP) is an independent risk factor for blood transfusion (BT) for postpartum hemorrhage (PPH), and whether risk factors for BT identified in single pregnancy also apply to twin pregnancy. Materials and Methods: A retrospective cohort study of consecutive women who gave birth at Jichi Medical University Hospital, Japan, between 1 April 2006 and 31 December 2016 was performed. Single or diamniotic twin deliveries producing healthy infants of ≥ 22 weeks were included. We analyzed the correlations between BT and 13 candidate risk factors that may be potentially associated with PPH in single and twin pregnancies. Results: We included 11,423 pregnancies: 10,523 (92.2%) single and 900 (7.8%) twin pregnancies. In single pregnancies, multivariate analysis indicated that placenta previa (PP), abruptio placentae, IP, chronic or gestational hypertension, preeclampsia (PE), HELLP syndrome, and tocolytic treatment (OR: 10.4, 19.1, 3.7, 3.6, 4.0, 18.9, and 2.0, respectively) were independent factors for the increased risk of allogenic BT. In twin pregnancies, multivariate analysis revealed that PP, abruptio placentae, IP, PE, and HELLP syndrome were independent factors for the increased risk of allogeneic BT (OR: 8.3, 103, 3.9, 4.3, and 39.6, respectively). Conclusion: IP was a novel risk factor for BT in both single and twin pregnancies. Although risk factors for BT were very similar between single and twin pregnancies, intravenous tocolysis was and was not a risk factor in single and twin pregnancies, respectively.

Highlights

Massive postpartum hemorrhage (PPH) often requires blood transfusion (BT), and BT administration around the time of delivery is often used as a surrogate marker of massive PPH
We extracted 13 candidate risk factors that may be potentially associated with allogeneic BT, namely maternal age, parity, previous CS, history of myomectomy, uterine myoma, low-lying placenta, placenta previa (PP), abruptio placentae, isolated proteinuria (IP), hypertensive disorder, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, tocolytic treatment, and cesarean section (CS)
We examined the following conditions and parameters: gestational hypertension and PE, proteinuria, HELLP syndrome, and tocolytic treatment

Summary

Introduction

Massive postpartum hemorrhage (PPH) often requires blood transfusion (BT), and BT administration around the time of delivery is often used as a surrogate marker of massive PPH. The presence of risk factors for BT allows obstetricians to prepare for PPH; identifying the risk factors is clinically significant. For massive PPH, and BT, a number of risk factors have been identified, including preeclampsia (PE) [16]. Several studies have reported that isolated proteinuria (IP), defined as proteinuria without hypertension, precedes PE, suggesting that IP and PE share a common pathophysiology [7,8,9]. We have long had the clinical impression that patients with IP more frequently suffer massive PPH, thereby requiring BT, than those without IP. Our first aim was to test our clinical impression, that is, whether IP is an independent risk factor for BT for PPH

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Discussion

Conclusion