Miller Sarah E, Leonard Stephanie A, Meza Pamela K, Ku Seul, Ren Lily Y, Lyell Deirdre J, Sultan Pervez, Butwick Alexander
Department of Obstetrics and Gynecology, the Department of Anesthesiology, Perioperative, and Pain Medicine, and the Lane Medical Library, Stanford University School of Medicine, Stanford, California.
Obstet Gynecol. 2023 Jan 1;141(1):49-58. doi: 10.1097/AOG.0000000000004976. Epub 2022 Nov 30.
To evaluate red blood cell use during delivery in patients with placenta accreta spectrum.
We searched MEDLINE, EMBASE, CINAHL, Cochrane Central, ClinicalTrials.gov, and Scopus for clinical trials and observational studies published between 2000 and 2021 in countries with developed economies.
Abstracts (n=4,275) and full-text studies (n=599) were identified and reviewed by two independent reviewers. Data on transfused red blood cells were included from studies reporting means and SDs, medians with interquartile ranges, or individual patient data. The primary outcome was the weighted mean number of units of red blood cells transfused per patient. Between-study heterogeneity was assessed with an I2 statistic. Secondary analyses included red blood cell usage by placenta accreta subtype.
TABULATION, INTEGRATION, AND RESULTS: Of the 599 full-text studies identified, 20 met criteria for inclusion in the systematic review, comprising 1,091 cases of placenta accreta spectrum. The number of units of red blood cells transfused was inconsistently described across studies, with five studies (25.0%) reporting means, 11 (55.0%) reporting medians, and four (20.0%) reporting individual patient data. The weighted mean number of units transfused was 5.19 (95% CI 4.12-6.26) per patient. Heterogeneity was high across studies (I2=91%). In a sensitivity analysis of five studies reporting mean data, the mean number of units transfused was 6.61 (95% CI 4.73-8.48; n=220 patients). Further quantification of units transfused by placenta accreta subtype was limited due to methodologic inconsistencies between studies and small cohort sizes.
Based on the upper limit of the CI in our main analysis and the high study heterogeneity, we recommend that a minimum of 6 units of red blood cells be available before delivery for patients with placenta accreta spectrum. These findings may inform future guidelines for predelivery blood ordering and transfusion support.
PROSPERO, CRD42021240993.
评估胎盘植入谱系疾病患者分娩期间红细胞的使用情况。
我们检索了MEDLINE、EMBASE、CINAHL、Cochrane Central、ClinicalTrials.gov和Scopus，以查找2000年至2021年期间在发达经济体国家发表的临床试验和观察性研究。
两名独立评审员对检索到的摘要（n = 4275篇）和全文研究（n = 599篇）进行了识别和评审。纳入了报告均值和标准差、中位数及四分位间距或个体患者数据的研究中关于输注红细胞的数据。主要结局是每位患者输注红细胞单位的加权平均数。采用I²统计量评估研究间的异质性。次要分析包括按胎盘植入亚型分析红细胞的使用情况。
制表、整合与结果：在识别出的599篇全文研究中，20篇符合纳入系统评价的标准，共纳入1091例胎盘植入谱系疾病患者。各研究中输注红细胞单位的数量描述不一致，5项研究（25.0%）报告了均值，11项研究（55.0%）报告了中位数，4项研究（20.0%）报告了个体患者数据。每位患者输注红细胞单位的加权平均数为5.19（95%CI 4.12 - 6.26）。研究间异质性较高（I² = 91%）。在对5项报告均值数据的研究进行的敏感性分析中，输注红细胞单位的平均数为6.61（95%CI 4.73 - 8.48；n = 220例患者）。由于研究间方法学不一致以及队列规模较小，按胎盘植入亚型进一步量化输注红细胞单位受到限制。
基于我们主要分析中CI的上限以及较高的研究异质性，我们建议对于胎盘植入谱系疾病患者，分娩前至少备有6单位红细胞。这些发现可能为未来分娩前血液备血和输血支持指南提供参考。
PROSPERO，CRD42021240993
