Kim et al developed a score for predicting the need for massive transfusion in a woman with placenta previa totalis. This can help to identify a patient who may require more aggressive management. The authors are from Catholic Kwandong University, Hallym University and University of Ulsan in Korea.
Patient selection: placenta previa totalis
Outcome: massive blood transfusion
Parameters:
(1) suspicion of placental adhesion
(2) number of previous caesarean sections
(3) gestational age at delivery in weeks
(4) anterior placenta
(5) sponge-like appearance of cervix
Parameter
Finding
Points
suspicion of placental adhesion
no
0
yes
2
previous caesarean sections
0
0
1
1
2
2
gestational age
< 37 weeks
1
>= 37 weeks
0
anterior placenta
no
0
yes
1
sponge-like cervix
no
0
yes
1
where:
• More than 2 caesarean sections will be assigned 2 points in the implementation.
• The presence of placental adhesion suggests placental accreta or increta.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• The higher the score the greater the risk of massive transfusion.
Total Score
Massive Transfusion
0
2%
1
7%
2
19%
3
44%
4
72%
5
90%
6
97%
7
99%
Performance:
• The area under the ROC curve is 0.84.
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