title: Predictors of massive blood loss in women with placenta accreta.
abstract: OBJECTIVE
  We examined predictors of massive blood loss for women with placenta accreta who had undergone hysterectomy.
  
  
  METHODS
  A retrospective review of women who underwent peripartum hysterectomy for pathologically confirmed placenta accreta was performed. Characteristics that are associated with massive blood loss (≥ 5000 mL) and large-volume transfusion (≥ 10 units packed red cells) were examined.
  
  
  RESULTS
  A total of 77 patients were identified. The median blood loss was 3000 mL, with a median of 5 units of red cells transfused. There was no association among maternal age, gravidity, number of previous deliveries, number of previous cesarean deliveries, degree of placental invasion, or antenatal bleeding and massive blood loss or large-volume transfusion (P > .05). Among women with a known diagnosis of placenta accreta, 41.7% had an estimated blood loss of ≥ 5000 mL, compared with 12.0% of those who did not receive the diagnosis antenatally with ultrasound scanning (P = .01).
  
  
  CONCLUSIONS
  There are few reliable predictors of massive blood loss in women with placenta accreta.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. jw2459@columbia.edu
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Shai
authors.initials: S
authors.lastname: Pri-Paz
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Monjri
authors.initials: M
authors.lastname: Shah
authors.forename: Clarissa
authors.initials: C
authors.lastname: Bonanno
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: Lynn L
authors.initials: LL
authors.lastname: Simpson
authors.forename: Sreedhar
authors.initials: S
authors.lastname: Gaddipati
authors.forename: Xuming
authors.initials: X
authors.lastname: Sun
authors.forename: Mary E
authors.initials: ME
authors.lastname: D'Alton
authors.forename: Patricia
authors.initials: P
authors.lastname: Devine
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography