Analysis Of Risk Factors For Massive Blood Transfusion And Placenta Accreta In Placenta Previa

Background and objective:Placenta previa(PP)is one of the most common complications during the gestation period which is reported to be present in 1.24%of the Chinese pregnant women.In recent years,the incidence of placenta previa has been increasing with the maternal age and the rate of cesarean section.PP mainly causes obstetric hemorrhage,even severe bleeding.Placenta accreta often combined with PP,and it is the main cause of intraoperative bleeding.Severe bleeding can lead to maternal shock,hysterectomy,premature delivery,neonatal asphyxia and neonatal death.Due to the influence of amniotic fluid factors,the amount of intraoperative blood loss has been questioned by several researchers.Therefore,the feasibility of assessing the amount of blood loss by intraoperative blood transfusion has been verified.At present,the blood resources of domestic are in a state of shortage,and insufficient blood supply can lead to an increase in adverse pregnancy outcomes.In order to reduce the incidence of adverse pregnancy,preoperative blood supply should be sufficient,and coordination with the departments of anesthesia surgery,blood transfusion,ICU,neonatology and interventional to ensure that the preoperative preparation is efficient.In the present study,we investigated associated risk factors for massive blood transfusion and placental accreta in women with placenta previa,in order to systematically manage pregnant women with placenta previa to reduce the incidence of adverse pregnancy outcomes.Method:A total of 554 consecutive cases of placenta previa,including 88 cases requiring numbers of blood transfusion,466 cases requiring non-large blood transfusion,317 cases combined with placenta accreta,237 cases without placenta accreta,were retrospectively analyzed.Maternal and neonatal clinical data were analyzed by various statistical methods to find the potential risk factors of massive blood transfusions and placenta accreta in women with placenta previa.Results:1.There were statistical differences in the number of gestational weeks,the number of births,the number of uterine operations,the amount of intraoperative blood loss,the total length of hospital stay,and the length of postoperative hospital stay between a large number of transfusion group and non-mass transfusion group.2.The difference was statistically significant at pregnancy,uterine surgery,intrauterine operation,conception of pregnancy,placenta previa type,placental position,timing of surgery,premature delivery,neonatal birthweight,and placenta accreta between the large number of transfusion groups and non-mass transfusion groups.There were statistical differences in complete placenta previa,anterior placenta,no less than 2 times of uterine surgery history,accreta between non-large blood transfusion group and massive blood transfusion group,placental implant had the highest OR value.3.Compared with the non-accreta group,the two groups had statistical differences in gestational weeks,delivery times,number of uterine operations,intraoperative blood loss,total hospital stay,and postoperative residence time.4.Uterine surgery,complete placenta previa,anterior placenta,pregnancy,and prenatal bleeding were statistically significant between the accreta and non-accreta groups.Complete placenta previa,anterior placenta,history of having uterine surgery in non-accreta group and accreta group were statistically significant;And the uterine surgery had the highest OR value.The OR of antepartum hemorrhage is 0.649.Conclusion:1.The need for massive blood transfusion in pregnant women with placenta previa is a common clinical phenomenon that needs to be taken seriously;2.Risk factors for massive blood transfusion in pregnant women with placenta previa are complete placenta previa,anterior wall placenta,at least 2 times of uterine surgery history and placenta implantation;Among the risk factors for massive blood transfusion,placenta accreta is the most important risk factor;3.Risk factors for placenta accreta in pregnant women with placenta previa are complete placenta previa,anterior placenta,and uterine surgery history;Among the risk factors,uterine surgery history is the most important risk factor;Antepartum hemorrhage is the protective factor.4.It is important to improve the clinical management of placenta previa from prenatal management,selective hospitalization and blood preparation,multidisciplinary consultation to make the best treatment plan,postoperative treatment of pregnant women and newborns as well as follow-up.