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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (5): 709-713    DOI: 10.31083/j.ceog.2020.05.5315
Original Research Previous articles | Next articles
Proteinuria as a novel risk factor for allogeneic blood transfusion irrespective of single or twin pregnancy
H. Takahashi1, *(), Y. Baba1, R. Usui1, S. Nagayama1, K. Horie1, A. Ohkuchi1, S. Matsubara1
1Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
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Abstract  

Objective: To clarify whether isolated proteinuria (IP) is an independent risk factor for blood transfusion (BT) for postpartum hemorrhage (PPH), and whether risk factors for BT identified in single pregnancy also apply to twin pregnancy. Materials and Methods: A retrospective cohort study of consecutive women who gave birth at Jichi Medical University Hospital, Japan, between 1 April 2006 and 31 December 2016 was performed. Single or diamniotic twin deliveries producing healthy infants of ≥ 22 weeks were included. We analyzed the correlations between BT and 13 candidate risk factors that may be potentially associated with PPH in single and twin pregnancies. Results: We included 11,423 pregnancies: 10,523 (92.2%) single and 900 (7.8%) twin pregnancies. In single pregnancies, multivariate analysis indicated that placenta previa (PP), abruptio placentae, IP, chronic or gestational hypertension, preeclampsia (PE), HELLP syndrome, and tocolytic treatment (OR: 10.4, 19.1, 3.7, 3.6, 4.0, 18.9, and 2.0, respectively) were independent factors for the increased risk of allogenic BT. In twin pregnancies, multivariate analysis revealed that PP, abruptio placentae, IP, PE, and HELLP syndrome were independent factors for the increased risk of allogeneic BT (OR: 8.3, 103, 3.9, 4.3, and 39.6, respectively). Conclusion: IP was a novel risk factor for BT in both single and twin pregnancies. Although risk factors for BT were very similar between single and twin pregnancies, intravenous tocolysis was and was not a risk factor in single and twin pregnancies, respectively.

Key words:  Cesarean section      Proteinuria      Tocolysis      Transfusion      Twin     
Submitted:  22 July 2019      Accepted:  16 October 2019      Published:  15 October 2020     
*Corresponding Author(s):  H. Takahashi     E-mail:  hironori@jichi.ac.jp

Cite this article: 

H. Takahashi, Y. Baba, R. Usui, S. Nagayama, K. Horie, A. Ohkuchi, S. Matsubara. Proteinuria as a novel risk factor for allogeneic blood transfusion irrespective of single or twin pregnancy. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 709-713.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.05.5315     OR     https://ceog.imrpress.com/EN/Y2020/V47/I5/709

Table 1  — Clinical characteristics of participants.
s
Singleton (n = 10,523) Twin (n = 900) p-value*
Maternal age (years) 33 (29-36) 32 (29-36) 0.198
Maternal age > 35 3,874 (36.8) 302 (33.6) 0.052
BMI (kg/m/m) 26.6 (23.5-29.2) 26.5 (24.2-30.2) 0.517
Multiparity 3,641 (34.6) 226 (25.1) < 0.001
Previous CS 2,101 (20.0) 56 (6.2) < 0.001
History of myomectomy 318 (3.0) 20 (2.2) 0.217
Uterine myoma 847 (8.0) 34 (3.8) < 0.001
Low lying placenta 205 (1.9) 10 (1.1) 0.095
Placenta previa 334 (3.2) 10 (1.1) < 0.001
Abruptio placentae 84 (0.8) 4 (0.4) 0.32
Isolated proteinuria 127 (1.2) 44 (4.9) < 0.001
Hypertensive disorder? 497 (4.7) 84 (9.3) < 0.001
HELLP syndrome 29 (0.3) 6 (0.7) 0.053
Tocolytic treatment? 806 (7.7) 543 (60.3) < 0.001
CS 4,835 (45.9) 858 (95.3) < 0.001
GA at delivery (day) 270 (263-279) 257 (245-261) < 0.001
Blood loss at delivery (mL) 475 (276-780) 900 (630-1,250) < 0.001
Allogeneic BT 132 (1.3) 31 (3.4) < 0.001
RBC (units) 6 (4-8) 4 (4-11) 0.688
FFP (units) 6 (4-10) 8 (4-12) 0.505
PC (units) 10 (10-20) 20 (20-20) 0.229
Table 2  — Risk factors for allogeneic blood transfusion in 10,523 singleton pregnancies.
Characteristics Allogeneic blood transfusion
(+) (n = 132) (-) (n = 10,391) Crude OR (95% CI) Adjusted OR* (95% CI)
Maternal age > 35 (years) 57 (43.2) 3,817 (36.7) 1.3 (0.9-1.9) -
Multiparity 49 (37.1) 3,592 (34.6) 1.1 (0.8-1.6) -
Previous CS 30 (22.7) 2,071 (19.9) 1.2 (0.8-1.8) -
History of myomectomy 4 (3.0) 314 (3.0) 1.0 (0.4-2.7) -
Uterine myoma 10 (7.6) 837 (8.1) 0.9 (0.5-1.8) -
Low lying placenta 1 (0.8) 204 (2.0) 0.4 (0.1-2.7) -
Placenta previa 38 (28.8) 296 (2.8) 13.8 (9.3-20.4) 10.4 (5.8-18.7)
Abruptio placentae 13 (9.8) 71 (0.7) 15.9 (8.6-29.5) 19.1 (9.7-37.7)
Isolated proteinuria 4 (3.0) 123 (1.2) 2.9 (1.1-8.0) 3.7 (1.3-10.8)
Hypertensive disorder
Chronic or gestational hypertension 10 (7.6) 309 (3.0) 2.9 (1.5-5.6) 3.6 (1.8-7.3)
Preeclampsia 8 (6.1) 170 (1.6) 4.2 (2.0-8.7) 4.0 (1.8-9.0)
HELLP syndrome 6 (4.5) 23 (0.2) 21.5 (8.6-53.6) 18.9 (7.0-50.9)
Tocolytic treatment 42 (31.8) 764 (7.4) 5.9 (4.1-8.5) 2.0 (1.2-3.4)
Cesarean section 97 (73.5) 4,738 (45.6) 3.3 (2.2-4.9) 1.3 (0.9-2.1)
Table 3  — Risk factors for allogeneic blood transfusion in 900 twin pregnancies.
Characteristics Allogeneic blood transfusion
(+) (n = 31) (-) (n = 869) Crude OR (95% CI) Adjusted OR* (95% CI)
Maternal age > 35 (years) 13 (41.9) 289 (33.3) 1.5 (0.7-3.0) -
Multiparity 8 (25.8) 218 (25.1) 1.0 (0.5-2.4) -
Previous CS 3 (9.7) 53 (6.1) 1.7 (0.5-5.6) -
History of myomectomy 2 (6.5) 18 (2.1) 3.3 (0.7-14.7) -
Uterine myoma 2 (6.5) 32 (3.7) 1.8 (0.4-7.9) -
Low lying placenta 2 (6.5) 8 (0.9) 7.4 (1.5-36.5) 2.2 (0.1-33.3)
Placenta previa 2 (6.5) 8 (0.9) 7.4 (1.5-36.5) 8.3 (1.6-44)
Abruptio placentae 3 (9.7) 1 (0.1) 93.0 (9.4-922) 103 (7.9-1,350)
Isolated proteinuria 3 (9.7) 41 (4.7) 3.3 (1.1-11.4) 3.9 (1.1-14.3)
Hypertensive disorder
Chronic or gestational hypertension 3 (9.7) 44 (5.1) 2.4 (0.7-8.5) 1.5 (0.3-7.1)
Preeclampsia 4 (12.9) 33 (3.8) 3.5 (1.1-10.6) 4.3 (1.4-13.5)
HELLP syndrome 3 (9.7) 3 (0.3) 30.9 (6.0-160) 39.6 (6.5-241)
Tocolytic treatment 19 (61.3) 524 (60.3) 1.0 (0.5-2.2) -
Cesarean section 31 (100) 827 (95.2) -
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