Risk factors for major bleeding in patients with placenta previa undergoing caesarean section
Abstract Number: S-30
Abstract Type: Original Research
Background: Obstetric haemorrhage is one of the leading causes of maternal death1.Hence it is important to identify those risk factors that are associated with increased risk of bleeding.
Methods: We performed a retrospective audit of blood loss in patients with placenta previa who underwent LSCS between 2002 and 2008. We collected the following data associated with risk of bleeding: age, parity, position and grade of placenta, type of anaesthesia and previous CS.
Results: 143 patients were identified during the audit of whom 27(19%) patients had major blood loss (>1500 ml or >5units RBC transfusion) in the operating theatre. Logistic regression analysis showed that the factors significantly associated with increased risk of major haemorrhage were anterior position of the placenta (OR 3.0; 95%CI 1.3 – 7.2; p = 0.012), general anaesthesia (OR4.0, 95%CI 1.6 – 9.9; p =0.003), parity of 3 or more (OR5.3, 95%CI 1.5 – 18.9; p =0.010), and previous caesarean section (OR 3.0, 95% CI 1.2 to 7.6: p=0.020). The grade of placenta was not associated with excessive risk of major haemorrhage (table attached).
Conclusions: Anterior position, general anaesthesia, parity of 3 or more and a history of previous caesarean section were significantly associated with major haemorrhage. Decision making regarding the risk of bleeding during Caesarean section for placenta previa should not be based on the grade of placenta previa as patients with lower grades are at similar risk of massive haemorrhage to patients with Grade 4.
1. Confidential Enquiry into Maternal and Child Health Saving Mothers’ Lives : Reviewing maternal deaths to make motherhood safer - 2003-2005