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Predicting peripartum blood transfusion in women undergoing cesarean delivery: A risk prediction model.

Publication ,  Journal Article
Ahmadzia, HK; Phillips, JM; James, AH; Rice, MM; Amdur, RL
Published in: PLoS One
2018

OBJECTIVE: There has been an appreciable rise in postpartum hemorrhage requiring blood transfusions in the United States. Our objective is to better define patients at greatest risk for peripartum transfusion at the time of cesarean in order to identify cases for early intervention and monitoring. METHODS: Our study is a secondary analysis of a retrospective cohort study. Cases of intraoperative and immediate postpartum blood transfusion among women undergoing cesarean delivery were identified. Multivariable logistic regression models were used to identify antepartum and intrapartum risk factors that were independently associated with blood transfusion. A risk calculator was then developed to predict the need for transfusion. RESULTS: Of 56,967 women, 1488 (2.6%) required any blood transfusion. The strongest risk factors for peripartum blood transfusion included anemia (odds ratio [OR] 3.7, 95% CI 3.3-4.3), abruption on presentation (OR 3.3, CI 2.6-4.1), general anesthesia (OR 5.2, CI 4.4-6.1) and abnormal placentation (OR 92.0, CI 57.4-147.6). An antepartum (model 1) and combined antepartum plus intrapartum risk model (model 2) were developed (model 1 AUC = 0.77, model 2 AUC = 0.83) and internally validated. CONCLUSIONS: Among women who required cesarean delivery, we were able to identify risk factors which predispose women to peripartum blood transfusion and developed a prediction model with good discrimination.

Duke Scholars

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2018

Volume

13

Issue

12

Start / End Page

e0208417

Location

United States

Related Subject Headings

  • Young Adult
  • Vaginal Birth after Cesarean
  • United States
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Recurrence
  • Puerperal Disorders
  • Prognosis
  • Pregnancy Complications
 

Citation

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Ahmadzia, H. K., Phillips, J. M., James, A. H., Rice, M. M., & Amdur, R. L. (2018). Predicting peripartum blood transfusion in women undergoing cesarean delivery: A risk prediction model. PLoS One, 13(12), e0208417. https://doi.org/10.1371/journal.pone.0208417
Ahmadzia, Homa K., Jaclyn M. Phillips, Andra H. James, Madeline M. Rice, and Richard L. Amdur. “Predicting peripartum blood transfusion in women undergoing cesarean delivery: A risk prediction model.PLoS One 13, no. 12 (2018): e0208417. https://doi.org/10.1371/journal.pone.0208417.
Ahmadzia HK, Phillips JM, James AH, Rice MM, Amdur RL. Predicting peripartum blood transfusion in women undergoing cesarean delivery: A risk prediction model. PLoS One. 2018;13(12):e0208417.
Ahmadzia, Homa K., et al. “Predicting peripartum blood transfusion in women undergoing cesarean delivery: A risk prediction model.PLoS One, vol. 13, no. 12, 2018, p. e0208417. Pubmed, doi:10.1371/journal.pone.0208417.
Ahmadzia HK, Phillips JM, James AH, Rice MM, Amdur RL. Predicting peripartum blood transfusion in women undergoing cesarean delivery: A risk prediction model. PLoS One. 2018;13(12):e0208417.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2018

Volume

13

Issue

12

Start / End Page

e0208417

Location

United States

Related Subject Headings

  • Young Adult
  • Vaginal Birth after Cesarean
  • United States
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Recurrence
  • Puerperal Disorders
  • Prognosis
  • Pregnancy Complications