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A total of 332 pregnant women with PAS were involved in this study. The average age was 33.4 years old, and the average gestational age at delivery was 36.0 weeks. Among them, the proportions of placenta acrreta, increta, and percreta were 44.0% (146/332), 39.8% (132/332), and 16.3% (54/332), respectively. Table 1 depicts the proportions of different surgical approaches. The median value of blood loss was 1,000 (500, 2,000), whereas the average ultrasonic score was 7 (5, 9) points.
Characteristics Value Maternal age, mean (s) 33.4 (4.4) Gestational age, mean (s) 36.0 (1.7) Year, n (%) 2015 39 (11.7) 2016 56 (16.9) 2017 94 (28.3) 2018 67 (20.2) 2019 76 (22.9) Gravidity (not include this pregnancy), n (%) 0−1 47 (14.1) 2−3 159 (47.9) 4 126 (37.9) Para, n (%) 0 78 (23.5) 1 209 (63.0) 2 43 (13.0) 3 2 (0.6) Placenta accreta spectrum, n (%) Placenta accreta 146 (44.0) Placenta increta 132 (39.8) Placenta precreta 54 (16.3) Surgical approaches, n (%) Cervical pull sutures 119 (35.8) Bilateral uterine artery ligation 246 (74.1) Focal sutures 201 (60.5) B-lynch sutures 182 (54.8) Hysterectomy 12 (3.6) Surgical teams, n (%)* 1 227 (68.4) 2 41 (12.3) 3 35 (10.5) 4 29 (8.7) Note: *Divided into four surgical teams according to the experience of surgical participants. Table 1. Baseline characteristics of cases with PAS
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The median value of blood loss was 1,000 (500, 2,000) mL, whereas the median value of ultrasonic score was 7 (5, 9) points. Table 2 presents the correlation between every single score value and blood loss. The median blood loss increased significantly as the score value increased. Similarly, the proportion of blood loss equal to or greater than 1,500 mL shows an increasing trend as the score increases. When the ultrasonic score was no more than 6 points, the median blood loss was no more than 1,000 mL, and the proportion of IBL ≥ 1,500 mL was below 30%. When the ultrasonic score was no more than 10 points, the proportion of IBL ≥ 1,500 mL was less than 50%.
Score Median (IQRs) of
blood loss (mL)Blood loss ≥ 1,500 mL,
n (%)1 700 (400, 1,000) 0 (0.0) 2 585 (400, 1,000) 2 (20.0) 3 500 (400, 600) 0 (0.0) 4 500 (400, 700) 4 (12.9) 5 500 (400, 1,000) 7 (14.6) 6 800 (500, 1,000) 4 (11.4) 7 1,000 (800, 1,500) 16 (35.6) 8 1,200 (800, 2,300) 19 (40.4) 9 1,350 (800, 2,400) 16 (47.1) 10 2,150 (1,350, 3,400) 18 (75.0) 11 2,550 (2,000, 3,950) 14 (87.5) 12 2,475 (1,500, 3,100) 10 (83.3) 13 2,650 (1,750, 4,000) 3 (75.0) 14 2,600 (1,200, 4,000) 1 (50.0) 15 4,000 (4,000, 4,000) 1 (100.0) Note. IQRs, interquartile ranges. Table 2. Status of intraoperative blood loss of every single ultrasonic score
Generalized additive models have been drawn to explore the correlation of score and blood loss after adjustment of multiple covariates mentioned before, as shown in Figure 2. All models show a significant positive correlation between score and blood loss (P < 0.05).
Figure 2. The correlation of ultrasonic score and intraoperative blood loss. Model A: adjusted for no covariate; Model B: adjusted for year of giving birth, maternal age, gravidity, parity, and gestational age at birth. Model C: surgical approaches and surgical teams were adjusted for in addition to the covariates in Model B.
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According to the ultrasonic score value, all cases were divided into three score groups: low, median, and high. Low score group refers to less than 6 points, whereas scores between 7 and 9 points refer to the median score group, and 10 points or more are considered as high score group. Table 3 shows the comparison of the results obtained from maternal age, gestational age, IBL, transfusion blood product, and hysterectomy rate in the three groups. It was found that there were significant differences in gestational age, IBL, blood transfusions, and hysterectomy rate except for maternal age. The higher score signifies earlier termination of gestational age. It was likely that delivery time would be 34 weeks of gestation in advance in a high score group, whereas cases in low score group often terminated the pregnancy at nearly 37 weeks. Similarly, IBL, transfusion proportion, packed red cell transfused, and hysterectomy rate increased as the ultrasonic score increased. The median of IBL was 600, 1,200, and 2,500 mL in three groups, respectively. The proportion of IBL ≥ 1,500 mL in three groups was 11.6%, 40.5%, 79.7%, respectively. Table 4 presents the lists of the risk of IBL ≥ 1,500 mL in three groups. The risk of median and high score groups was 5.20 and 29.95 times compared with the low score group prior to covariate adjustments. After the adjustment of all covariates, the high score group remained at a high risk, which was 15.09 times than the low score group.
Group Low score Median score High score P value* n 147 126 59 Age (years), mean (SD) 34.0 (4.0) 33.0 (5.0) 34.0 (5.0) 0.376 Gestational age (weeks), mean (SD) 36.7 (1.5) 35.9 (1.6) 34.5 (1.4) 0.000 IBL (mL), median (IQR) 600 (400, 1,000) 1,200 (800, 2,000) 2,500 (1,500, 3,800) 0.000 Transfused, n (%) 37 (25.2%) 82 (65.1%) 57 (96.6%) 0.000 Packed red cell (mL), median (IQR) 0 (0, 400) 400 (0, 1,200) 1,200 (800, 2,400) 0.000 Hysterectomy, n (%) 1 (0.7) 3 (2.4) 8 (13.6) 0.000 Note. *Data were analyzed by chi-square test. IBL, intraoperative blood loss. Table 3. Comparison of different groups based on the ultrasonic score
Score Model A Model B Model C OR (95% CI) P OR (95% CI) P OR (95% CI) P 1−6 1.00 1.00 1.00 7−9 5.20 (2.80, 9.65) 0.000 6.94 (3.46, 13.94) 0.000 2.03 (0.82, 5.02) 0.126 10−15 29.95 (13.31, 67.38) 0.000 69.49 (22.84, 211.38) 0.000 15.09 (3.85, 59.19) < 0.001 Note. OR, odds ratio; CI; confidence interval; IBL, intraoperative blood loss. Table 4. Risk of IBL ≥ 1,500 mL in three groups
Correlation of An Ultrasonic Scoring System and Intraoperative Blood Loss in Placenta Accreta Spectrum Disorders: A Retrospective Cohort Study
doi: 10.3967/bes2021.022
- Received Date: 2020-08-04
- Accepted Date: 2020-12-04
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Key words:
- Ultrasonic scoring system /
- Intraoperative blood loss /
- Placenta accreta spectrum disorders
Abstract:
Citation: | CHEN Lian, SHI Hui Feng, JIANG Hai, SHI Xiao Ming, WANG Yuan Yuan, ZHANG Ai Qing, CHONG Yi Wen, ZHAO Yang Yu. Correlation of An Ultrasonic Scoring System and Intraoperative Blood Loss in Placenta Accreta Spectrum Disorders: A Retrospective Cohort Study[J]. Biomedical and Environmental Sciences, 2021, 34(2): 163-169. doi: 10.3967/bes2021.022 |