Objective: To study the risk factors associated with massive blood loss among women with placenta previa/accreta.
Methods: This prospective cohort study was conducted at the department of obstetrics and gynecology at Fayoum University from September 2021 to February 2023. This study recruited women diagnosed with placenta previa/accreta spectrum according to prespecified inclusion and exclusion criteria. The diagnosis was confirmed by MRI. All risk factors for massive blood loss either obtained by history, ultrasound findings, and MRI findings were evaluated.
Results: Patients who lost ≥2000 cc had significantly higher parity, number of CS, and shorter interpregnancy interval (P value <0.001, < 0.001, and 0.003 respectively). Gravidity (P=0.015), parity (P=0.002), number of CS (p<0.001), and pregnancy complications (P=0.03) were significant predictors of massive blood loss. Certain ultrasound (lost placental and uterine regularity, bladder serosa interface and myometrial thinning, and placental lacunae) and MRI findings (evidence of focal bulge T2 dark spot) predicted massive blood loss significantly.
Conclusion: MRI is very important in the diagnosis of placenta previa/accreta. The developing of a scoring system for the prediction of intrapartum blood loss is paramount.