Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation

Kathleen Brookfield, Lawrence T. Goodnough, Deirdre J. Lyell, Alexander J. Butwick

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background Women with placenta increta (PI) and placenta percreta (PP) are at high risk of obstetric hemorrhage; however, the severity of hemorrhage and perioperative morbidity may differ according to the degree of placental invasion. We sought to compare blood component usage and perioperative morbidity between women with PI versus PP undergoing cesarean hysterectomy (CH). Study Design and Methods We identified 77 women who underwent CH for PI or PP from the NICHD MFMU Network Cesarean Registry, which sourced data from 19 centers from 1999 to 2002. We examined demographic, obstetric, and surgical data and rates of transfusion and perioperative morbidity. We performed statistical tests for between-group analyses; pvalues less than 0.05 were significant. Results Rates of intraoperative or postoperative red blood cell (RBC) transfusion were similar between groups (PI84% vs. PP88%; p=0.7). We observed no between-group differences in rates of fresh-frozen plasma (FFP) transfusion (intraoperative FFP - PI30% vs. PP41%; p=0.3; postoperative FFP - PI28% vs. PP18%; p=0.4) or platelet (PLT) transfusion (intraoperative PLTs - PI14% vs. PP29%; p=0.2; postoperative PLTs - PI9% vs. PP9%; p=1.0). Among the morbidities, a higher proportion of PP women underwent cystotomy (PI14% vs. PP38%; p=0.02) and postoperative mechanical ventilation (PI14% vs. PP35%; p=0.03). Conclusion Rates of intraoperative RBC, FFP, and PLT transfusion are similar for PI and PP women, and perioperative outcomes are worse for PP women. We suggest the same mobilization transfusion medicine support for both groups, including blood ordering (type and cross-match for CH) and availability of emergency blood protocols including fibrinogen-containing preparations.

Original languageEnglish (US)
Pages (from-to)1530-1536
Number of pages7
JournalTransfusion
Volume54
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Placenta Accreta
Placentation
Hysterectomy
Morbidity
Platelet Transfusion
Obstetrics
Cystotomy
National Institute of Child Health and Human Development (U.S.)
Hemorrhage
Transfusion Medicine
Erythrocyte Transfusion
Blood Group Antigens
Artificial Respiration
Fibrinogen
Registries
Emergencies
Erythrocytes
Demography

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation. / Brookfield, Kathleen; Goodnough, Lawrence T.; Lyell, Deirdre J.; Butwick, Alexander J.

In: Transfusion, Vol. 54, No. 6, 2014, p. 1530-1536.

Research output: Contribution to journalArticle

Brookfield, Kathleen ; Goodnough, Lawrence T. ; Lyell, Deirdre J. ; Butwick, Alexander J. / Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation. In: Transfusion. 2014 ; Vol. 54, No. 6. pp. 1530-1536.
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title = "Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation",
abstract = "Background Women with placenta increta (PI) and placenta percreta (PP) are at high risk of obstetric hemorrhage; however, the severity of hemorrhage and perioperative morbidity may differ according to the degree of placental invasion. We sought to compare blood component usage and perioperative morbidity between women with PI versus PP undergoing cesarean hysterectomy (CH). Study Design and Methods We identified 77 women who underwent CH for PI or PP from the NICHD MFMU Network Cesarean Registry, which sourced data from 19 centers from 1999 to 2002. We examined demographic, obstetric, and surgical data and rates of transfusion and perioperative morbidity. We performed statistical tests for between-group analyses; pvalues less than 0.05 were significant. Results Rates of intraoperative or postoperative red blood cell (RBC) transfusion were similar between groups (PI84{\%} vs. PP88{\%}; p=0.7). We observed no between-group differences in rates of fresh-frozen plasma (FFP) transfusion (intraoperative FFP - PI30{\%} vs. PP41{\%}; p=0.3; postoperative FFP - PI28{\%} vs. PP18{\%}; p=0.4) or platelet (PLT) transfusion (intraoperative PLTs - PI14{\%} vs. PP29{\%}; p=0.2; postoperative PLTs - PI9{\%} vs. PP9{\%}; p=1.0). Among the morbidities, a higher proportion of PP women underwent cystotomy (PI14{\%} vs. PP38{\%}; p=0.02) and postoperative mechanical ventilation (PI14{\%} vs. PP35{\%}; p=0.03). Conclusion Rates of intraoperative RBC, FFP, and PLT transfusion are similar for PI and PP women, and perioperative outcomes are worse for PP women. We suggest the same mobilization transfusion medicine support for both groups, including blood ordering (type and cross-match for CH) and availability of emergency blood protocols including fibrinogen-containing preparations.",
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AU - Brookfield, Kathleen

AU - Goodnough, Lawrence T.

AU - Lyell, Deirdre J.

AU - Butwick, Alexander J.

PY - 2014

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N2 - Background Women with placenta increta (PI) and placenta percreta (PP) are at high risk of obstetric hemorrhage; however, the severity of hemorrhage and perioperative morbidity may differ according to the degree of placental invasion. We sought to compare blood component usage and perioperative morbidity between women with PI versus PP undergoing cesarean hysterectomy (CH). Study Design and Methods We identified 77 women who underwent CH for PI or PP from the NICHD MFMU Network Cesarean Registry, which sourced data from 19 centers from 1999 to 2002. We examined demographic, obstetric, and surgical data and rates of transfusion and perioperative morbidity. We performed statistical tests for between-group analyses; pvalues less than 0.05 were significant. Results Rates of intraoperative or postoperative red blood cell (RBC) transfusion were similar between groups (PI84% vs. PP88%; p=0.7). We observed no between-group differences in rates of fresh-frozen plasma (FFP) transfusion (intraoperative FFP - PI30% vs. PP41%; p=0.3; postoperative FFP - PI28% vs. PP18%; p=0.4) or platelet (PLT) transfusion (intraoperative PLTs - PI14% vs. PP29%; p=0.2; postoperative PLTs - PI9% vs. PP9%; p=1.0). Among the morbidities, a higher proportion of PP women underwent cystotomy (PI14% vs. PP38%; p=0.02) and postoperative mechanical ventilation (PI14% vs. PP35%; p=0.03). Conclusion Rates of intraoperative RBC, FFP, and PLT transfusion are similar for PI and PP women, and perioperative outcomes are worse for PP women. We suggest the same mobilization transfusion medicine support for both groups, including blood ordering (type and cross-match for CH) and availability of emergency blood protocols including fibrinogen-containing preparations.

AB - Background Women with placenta increta (PI) and placenta percreta (PP) are at high risk of obstetric hemorrhage; however, the severity of hemorrhage and perioperative morbidity may differ according to the degree of placental invasion. We sought to compare blood component usage and perioperative morbidity between women with PI versus PP undergoing cesarean hysterectomy (CH). Study Design and Methods We identified 77 women who underwent CH for PI or PP from the NICHD MFMU Network Cesarean Registry, which sourced data from 19 centers from 1999 to 2002. We examined demographic, obstetric, and surgical data and rates of transfusion and perioperative morbidity. We performed statistical tests for between-group analyses; pvalues less than 0.05 were significant. Results Rates of intraoperative or postoperative red blood cell (RBC) transfusion were similar between groups (PI84% vs. PP88%; p=0.7). We observed no between-group differences in rates of fresh-frozen plasma (FFP) transfusion (intraoperative FFP - PI30% vs. PP41%; p=0.3; postoperative FFP - PI28% vs. PP18%; p=0.4) or platelet (PLT) transfusion (intraoperative PLTs - PI14% vs. PP29%; p=0.2; postoperative PLTs - PI9% vs. PP9%; p=1.0). Among the morbidities, a higher proportion of PP women underwent cystotomy (PI14% vs. PP38%; p=0.02) and postoperative mechanical ventilation (PI14% vs. PP35%; p=0.03). Conclusion Rates of intraoperative RBC, FFP, and PLT transfusion are similar for PI and PP women, and perioperative outcomes are worse for PP women. We suggest the same mobilization transfusion medicine support for both groups, including blood ordering (type and cross-match for CH) and availability of emergency blood protocols including fibrinogen-containing preparations.

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SN - 0041-1132

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