title: A combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa.
abstract: OBJECTIVE
  To generate a combined ultrasound and clinical model predictive for peripartum complications in pregnancies complicated by placenta previa.
  
  
  METHODS
  This study included 110 singleton pregnant women with placenta previa delivered by cesarean section (CS) from July 2011 to November 2013. We prospectively collected ultrasound and clinical data before CS and observed the occurrence of blood transfusion, uterine artery embolization and cesarean hysterectomy. We formulated a scoring model including type of previa (0: partials, 2: totalis), lacunae (0: none, 1: 1-3, 2: 4-6, 3: whole), uteroplacental hypervascularity (0: normal, 1: moderate, 2: severe), multiparity (0: no, 1: yes), history of CS (0: none, 1: once, 2: ≥ twice) and history of placenta previa (0: no, 1: yes) to predict the risk of peripartum complications.
  
  
  RESULTS
  In our study population, the risk of perioperative transfusion, uterine artery embolization, and cesarean hysterectomy were 26.4, 1.8 and 6.4%, respectively. The type of previa, lacunae, uteroplacental hypervascularity, parity, history of CS, and history of placenta previa were associated with complications in univariable analysis. However, no factor was independently predictive for any complication in exact logistic regression analysis. Using the scoring model, we found that total score significantly correlated with perioperative transfusion, cesarean hysterectomy and composite complication (p<0.0001, Cochrane Armitage test). Notably, all patients with total score ≥7 needed cesarean hysterectomy. When total score was ≥6, three fourths of patients needed blood transfusion.
  
  
  CONCLUSIONS
  This combined scoring model may provide useful information for prediction of peripartum complications in women with placenta previa.
authors: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: So-Yeon
authors: SY
authors: Yoon
authors: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Ji Yeon
authors: JY
authors: You
authors: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Suk-Joo
authors: SJ
authors: Choi
authors: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Soo-Young
authors: SY
authors: Oh
authors: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Jong-Hwa
authors: JH
authors: Kim
authors: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: crroh@skku.edu.
authors: Cheong-Rae
authors: CR
authors: Roh
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002585:Cesarean Section; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D008297:Male; D058725:Peripartum Period; D010923:Placenta Previa / Q000000981:diagnostic imaging*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D014463:Ultrasonography; D055357:Uterine Artery Embolization / Q000706:statistics & numerical data*
keywords: Complication; Placenta previa; Ultrasonography