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Study to investigate the association between placenta accreta subtype and red blood cell transfusion
Abstract Number: T-53
Abstract Type: Original Research
Objective: Women with abnormal placentation are at increased risk of massive transfusion. Determining red blood cell (RBC) requirements according to the degree of abnormal placentation may help tailor predelivery RBC ordering. This retrospective study investigated the association between number of transfused RBCs and placentation subtype.
Study Design: An institution-specific pathology database was searched for women delivered between 7/2009-7/2014 suspected of abnormal placentation based on documentation of radiologic evidence and/or clinical suspicion at the time of delivery. We abstracted clinical, laboratory and pathology data from medical records and the pathology database for all women with or without abnormal placentation. Based on the pathology report, placental subtypes were classified as: no accreta (NA), microscopic placenta accreta (MPA), non-microscopic placenta accreta (NMPA), placenta increta or placenta percreta (PIPP). We compared number of transfused RBCs between women with different placental subtypes using Kruskal-Wallis test. Multivariate linear regression was used to determine whether placental subtype was associated with the number of transfused RBCs, after adjusting for: maternal age, known placenta previa, and number of prior cesarean deliveries. P<0.05 considered as statistically significant.
Results: The study cohort comprised 136 women. Placental subtypes were: 42 (31%) NA, 39 (29%) MPA, 21 (15%) NMPA, and 34 (25%) PIPP. The median [IQR] number of RBCs transfused during the hospitalization period differed according to the degree of placentation: NA=0 [0-0] units; MPA=0 [0-2] units; NMPA=4 [0-11] units and PIPP=6 [2-6] units; P<0.001. In the adjusted model, the number of transfused RBCs was not independently associated with placental subtype (Table). However, compared to women with NA, RBC requirements were non-significantly higher for women with PA and PIPP.
Conclusion: Our study provides evidence that women with PA and PIPP have higher peripartum RBC requirements than women with NA. As our cohort size was limited, population-wide studies are needed to examine whether the degree of placentation is significantly associated with transfused RBC.