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Cited by 54Maternal and fetal healthcareBlood transfusion and managementPregnancy and preeclampsia studies

Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation

Open access
Brookfield, Kathleen F., Goodnough, Lawrence T., Lyell, Deirdre J., Butwick, Alexander J.·2014·Transfusion
DOI 10.1111/trf.12483PMC PMC4009387
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Abstract

Background: Women with placenta increta (PI) and placenta percreta (PP) are at high risk of obstetric hemorrhage; however, the severity of hemorrhage and perioperative morbidity may differ according to the degree of placental invasion. We sought to compare blood component usage and perioperative morbidity between women with PI versus PP undergoing cesarean hysterectomy (CH). Study Design and Methods: We identified 77 women who underwent CH for PI or PP from the NICHD MFMU N etwork C esarean R egistry, which sourced data from 19 centers from 1999 to 2002. We examined demographic, obstetric, and surgical data and rates of transfusion and perioperative morbidity. We performed statistical tests for between‐group analyses; p values less than 0.05 were significant. Results: Rates of intraoperative or postoperative red blood cell (RBC) transfusion were similar between groups (PI 84% vs. PP 88%; p = 0.7). We observed no between‐group differences in rates of fresh‐frozen plasma (FFP) transfusion (intraoperative FFP—PI 30% vs. PP 41%; p = 0.3; postoperative FFP—PI 28% vs. PP 18%; p = 0.4) or platelet (PLT) transfusion (intraoperative PLTs—PI 14% vs. PP 29%; p = 0.2; postoperative PLTs—PI 9% vs. PP 9%; p = 1.0). Among the morbidities, a higher proportion of PP women underwent cystotomy (PI 14% vs. PP 38%; p = 0.02) and postoperative mechanical ventilation (PI 14% vs. PP 35%; p = 0.03). Conclusion: Rates of intraoperative RBC, FFP, and PLT transfusion are similar for PI and PP women, and perioperative outcomes are worse for PP women. We suggest the same mobilization transfusion medicine support for both groups, including blood ordering (type and cross‐match for CH) and availability of emergency blood protocols including fibrinogen‐containing preparations.

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  • The main risk associated with the delivery of placenta accreta spectrum is massive haemorrhage and its associated complications, such as coagulopathy, multisystem organ failure and death.

    “The main risk associated with the delivery of placenta accreta spectrum is massive haemorrhage and its associated complications, such as coagulopathy, multisystem organ failure and death.”

    From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [172]

    The Introduction identifies major hemorrhage and very high blood loss at delivery as risks of abnormal placentation. The Discussion says major obstetric hemorrhage can cause coagulopathy. Our copy does not identify multisystem organ failure or death as complications of delivery with placenta accreta spectrum; its mention of reduced death risk concerns treatment of traumatic hemorrhage in non-obstetric patients. (LLM, conf=0.86)

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  • Many women with placenta accreta spectrum require massive blood transfusion (8 units or more) and their median platelet count is lowest compared with other causes of massive PPH.

    “Many women with placenta accreta spectrum require massive blood transfusion (8 units or more) and their median platelet count is lowest compared with other causes of massive PPH.171,172”

    From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [172]

    The Results report massive RBC transfusion (>8 units) in 14% of women with placenta increta and 29% with placenta percreta, supporting the transfusion part of the claim. They say platelet counts were similar between those two groups; the paper does not compare their median platelet counts with other causes of massive postpartum hemorrhage. (LLM, conf=0.88)

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Research works printed but not linked: 1

  1. [15]Tan SG Jobling TW Wallace EM McNeilage LJ Manolitsas T Hodges RJ Surgical management of placenta accreta: a 10-year experience Acta Obstet Gynecol Scand 2013 92 445 450 23311505

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Authors
Brookfield, K. F., Goodnough, L. T., Lyell, D. J., & Butwick, A. J.
Affiliations
Stanford Medicine (US)
Corresponding author
Butwick, Alexander J.
ORCID
Venue
Transfusion
Publisher
Wiley
Published
2013-11-04
Volume
54
Issue
6
Pages
1530-1536
ISSN
  • 0041-1132 (ISSN-L)
  • 1537-2995
DOI
10.1111/trf.12483
PMC
PMC4009387
OpenAlex
W1495507159
Cited by
54
References
28
Citations by year
2026: 2 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 4 · 2020: 7 · 2019: 7 · 2018: 7 · 2017: 4 · 2016: 2 · 2015: 4 · 2014: 1
FWCI
2.17
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Transfusion (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD070972)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Keywords
placenta increta, placenta percreta, cesarean hysterectomy, abnormal placentation, obstetric hemorrhage, blood transfusion, red blood cell transfusion, fresh frozen plasma, platelet transfusion, perioperative morbidity, cystotomy, mechanical ventilation
MeSH terms
Adolescent, Adult, Blood Transfusion, Cesarean Section, Female, Humans, Hysterectomy, Placenta Accreta, Placentation, Plasma, Pregnancy, Erythrocyte Transfusion, Young Adult

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