Abstract
BackgroundPlacenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa.Materials and MethodsWe included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss). Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage.ResultsOf 256 pregnant women with placenta previa, 96 (38%) developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was −0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >−0.33 (odds ratio, 5.88; 95% confidence interval, 3.04–12.00), need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79–6.25), and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85–92.13) were independent risk of intraoperative massive hemorrhage.ConclusionIn patients with placenta previa, a birth weight >−0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on this result, further studies are required to investigate whether fetal weight estimated by ultrasonography can predict hemorrhage during cesarean section in patients with placental previa.
Highlights
The prevalence of placenta previa is approximately four cases in 1000 pregnancies [1]
We calculated measured birth weights and standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age
Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71
Summary
The prevalence of placenta previa is approximately four cases in 1000 pregnancies [1]. Placenta previa is a well-known cause of massive intrapartum hemorrhage that is associated with high mortality and morbidity for both the mother and the neonate [3,4]. For these patients, preparation for possible severe perinatal bleeding is necessary and reliable predictive factors of hemorrhage are important [5,6]. Several risk factors of intraoperative massive hemorrhage in patients with placenta previa have been reported [7,8,9,10,11,12,13,14] Among these factors, those concerning maternal background were high maternal age and previous cesarean section [7,8]. We estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa
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