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36. Development of a scoring system to predict massive postpartum transfusion in placenta previa totalis

Author

Kim, Jung-Won, Lee, Yoon-Kyung, Chin, Ji-Hyun, Kim, Seon-Ok, Lee, Mi-Young, Won, Hye-Sung, and Choi, Woo-Jong

Subjects
Diagnosis, Prevention, Usage, Risk factors, Health aspects, Placenta previa -- Research -- Complications and side effects -- Risk factors -- Prevention, Placental abruption -- Diagnosis, Blood transfusion -- Research -- Health aspects, Magnetic resonance imaging -- Usage
Abstract

Author(s): Jung-Won Kim [sup.1] , Yoon-Kyung Lee [sup.2] , Ji-Hyun Chin [sup.3] , Seon-Ok Kim [sup.4] , Mi-Young Lee [sup.5] , Hye-Sung Won [sup.5] , Woo-Jong Choi [sup.3] Author Affiliations: [...], Purpose It is important to predict massive postpartum hemorrhage in patients with placenta previa totalis (PPT) and a method that accurately predicts this event is needed. The present study developed a scoring system that predicts massive transfusion in patients with PPT. Methods This single-center retrospective cohort study comprised 238 patients with PPT who underwent caesarean section between January 2004 and December 2010. Massive transfusion was defined as the transfusion of [greater than or equal to]8 units of packed red blood cells within 24 h after delivery. Multivariate regression analysis was used to estimate the risks of massive transfusion. A probability score model was then constructed and tested for performance. Subsequently, the model was validated in other patients with PPT (n = 117). Results Thirty-one patients (13.0%) underwent massive transfusion. Ultrasound suspicion of placental adhesion, previous caesarean section, gestational age Conclusion The scoring system developed using the five independent risk factors had better performance to predict massive transfusion in patients with PPT than when suspicion of placental adhesion was used alone. However, further large-scale studies are warranted to clarify the usefulness and accuracy of this model.

Published
2017
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47. Adult‐onset megacolon with focal hypoganglionosis: A detailed phenotyping and prospective cohort study.

Author

Yoon, Jiyoung, Jung, Kee Wook, Ham, Nam Seok, Kim, Jihun, Do, Yoon Suh, Kim, Seon Ok, Choi, Sang Hyun, Kim, Dong Wook, Hwang, Sung Wook, Park, Sang Hyoung, Yang, Dong‐Hoon, Ye, Byong Duk, Byeon, Jeong‐Sik, Yoon, Yong Sik, Kim, Chan Wook, Yu, Chang Sik, Jung, Hwoon‐Yong, Yang, Suk‐Kyun, Martin, Joanne E., and Knowles, Charles H.

Subjects
LONGITUDINAL method, COHORT analysis, THERAPEUTICS, T cells, SATISFACTION
Abstract

Background: In this prospective cohort study, we evaluated features of "adult‐onset megacolon with focal hypoganglionosis." Methods: We assessed the radiologic, endoscopic, and histopathologic phenotyping and treatment outcomes of 29 patients between 2017 and 2020. Data from community controls, consisting of 19,948 adults undergoing health screenings, were analyzed to identify risk factors. Experts reviewed clinical features and pathological specimens according to the London Classification for gastrointestinal neuromuscular pathology. Key results: The median age of the patients with adult‐onset megacolon with focal hypoganglionosis at symptom onset was 59 years (range, 32.0–74.9 years), with mean symptom onset only 1 year before diagnosis. All patients had focal stenotic regions with proximal bowel dilatation (mean diameter, 78.8 mm; 95% confidence interval [CI], 72–86). The comparison with community controls showed no obvious risk factors. Ten patients underwent surgery, and all exhibited significant hypoganglionosis: 5.4 myenteric ganglion cells/cm (interquartile range [IQR], 3.7–16.4) in the stenotic regions compared to 278 cells/cm (IQR, 190–338) in the proximal and 95 cells/cm (IQR, 45–213) in the distal colon. Hypoganglionosis was associated with CD3+ T cells along the myenteric plexus. Colectomy was associated with significant symptom improvement compared to medical treatment [change in the Global Bowel Satisfaction score, −5.4 points (surgery) vs. ‐0.3 points (medical treatment); p < 0.001]. Conclusions and inferences: Adult‐onset megacolon with focal hypoganglionosis has distinct features characterized by hypoganglionosis due to inflammation. Bowel resection appears to benefit these patients. [ABSTRACT FROM AUTHOR]

Published
2023
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