Is it possible to predict severe postpartum hemorrhage and need for massive transfusion in placenta previa cases?

Abstract

Abstract Purpose We aimed to construct a trustable working model for the placenta previa (PP) patients that helps to predict the postpartum bleeding potential with the input gained from the antenatal imaging studies, namely ultrasound (US) and Magnetic Resonance Imaging (MRI). Materials and Methods Forty-three PP patients were evaluated first by US and then 3 Tesla MRI. Placenta Accreata Index (PAI) was utilized during US evaluation in order to define the risks. Uterine bulging, heterogeneous signal, dark placental bands, focal interruption of myometrium and, tenting of bladder wall were regarded as predictive criterions in MRI evaluations. The correlation between the findings gained from US and MRI studies and haemorrhage (> 1000 ml), severe haemorrhage (> 2000 ml) and, massive transfusion (> 5 units of RBC) need was investigated to build this predictive model. The findings from the imaging studies were also confirmed histopathologically Results In the multivariate analysis of data from patients in either group of classification according to set point of 1000 ml., none of MRI and ultrasound findings were found to be predictive. The multivariate analysis done in second classification group (bleeding > 2000ml or more) PAI values (OR:2.3(1.4–3.8)) and overall MRI reported PAS (OR:4.9 (1.8–12.9)) were detected as predictive findings. While MRI findings were not discriminative between transfusion groups, grade 3 loculation in ultrasound examination was found to be predictive for need of transfusion more than 5 units (OR: 67,5 (8,2-549,4)). We had no cases of hysterectomy. Conclusions The ultrasound and MRI findings of PP cases can be useful to predict postpartum bleeding.