The nightmare of obstetricians — the placenta accreta spectrum in primiparous pregnant women
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Abstract
Objectives: The incidence of PAS is increasing day by day as a life-threatening condition. The purpose of the present study was to determine the factors affecting PAS formation in primiparous pregnant women and to define possible risk factors for the mother and the baby. Material and methods: Bursa Yüksek İhtisas Training and Research Hospital, department of obstetrics and gynecology, Bursa, Turkey, between June 2016 and December 2020. A total of 58,895 patients were included in the study. After the exclusion criteria, the study was continued with 27 primiparous PAS and 54 non-primiparous PAS patients. The primary purpose is to evaluate PAS risk factors. The secondary aim is to examine maternal and neonatal characteristics. Results: When the parameters that are significant in terms of PAS risk factors were analyzed by Logistic Regression Analysis, it was found that the increase in age also increased the development of PAS 1.552 times (95% CI: 1.236–1.948) and a history of abortion was 7.928. times (95% CI: 1.408–44.654) and 11,007 times (95% CI: 2.059–58.832) with history of myomectomy; postoperative HB values (p < 0.001), an estimated amount of bleeding (p < 0.001), need for transfusion (p = 0.002), and use of drains ( < 0.001) were statistically significant different between two groups. When the neonatal results between patients with and without PAS were examined, birth weight (p < 0.001) and gestational week ( < 0.001) were statistically significant. Conclusions: PAS does not occur only in multiparous patients who have a history of previous cesarean section. It may also occur in primiparous patients and is a life-threatening condition.
Keywords: spectrum of placenta accretahigh risk pregnancyprimiparous pregnancy
References
- Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006; 107(4): 927–941.
- Tantbirojn P, Crum CP, Parast MM. Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta. 2008; 29(7): 639–645.
- Khong TY. The pathology of placenta accreta, a worldwide epidemic. J Clin Pathol. 2008; 61(12): 1243–1246.
- Laoreti A, Thilaganathan B, Kaelin Agten A, et al. Placental thickness in the lower uterine segment and invasive placentation: Will the promise live up? Acta Obstet Gynecol Scand. 2019; 98(2): 266.
- Young BC, Nadel A, Kaimal A. Does previa location matter? Surgical morbidity associated with location of a placenta previa. J Perinatol. 2014; 34(4): 264–267.
- Altinkaya SO, Nergiz S, Guldas M, et al. Antepartum risk factors for peripartum hysterectomy in women with placenta previa. Gynecol Obstet Reprod Med. 2016; 20(01): 24–28.
- Sentilhes L, Kayem G, Silver RM. Conservative Management of Placenta Accreta Spectrum. Clin Obstet Gynecol. 2018; 61(4): 783–794.
- Badr DA, Al Hassan J, Salem Wehbe G, et al. Uterine body placenta accreta spectrum: A detailed literature review. Placenta. 2020; 95: 44–52.
- Grobman WA, Gersnoviez R, Landon MB, et al. National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network, National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006; 107(6): 1226–1232.
- Farquhar CM, Li Z, Lensen S, et al. Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study. BMJ Open. 2017; 7(10): e017713.
- Senkoro EE, Mwanamsangu AH, Chuwa FS, et al. Frequency, Risk Factors, and Adverse Fetomaternal Outcomes of Placenta Previa in Northern Tanzania. J Pregnancy. 2017; 2017: 5936309.
- Baldwin HJ, Patterson JA, Nippita TA, et al. Maternal and neonatal outcomes following abnormally invasive placenta: a population-based record linkage study. Acta Obstet Gynecol Scand. 2017; 96(11): 1373–1381.
- Lindqvist PG, Thurn L, Thurn L, et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG. 2016; 123(8): 1348–1355.
- Baldwin HJ, Patterson JA, Nippita TA, et al. Antecedents of Abnormally Invasive Placenta in Primiparous Women: Risk Associated With Gynecologic Procedures. Obstet Gynecol. 2018; 131(2): 227–233.
- World Health Organization (Trends In Maternal Mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division Geneva, 2019.
- Iacovelli A, Liberati M, Khalil A, et al. Risk factors for abnormally invasive placenta: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020; 33(3): 471–481.
- Fitzpatrick KE, Sellers S, Spark P, et al. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One. 2012; 7(12): e52893.
- Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997; 177(1): 210–214.
- Jacques SM, Qureshi F, Trent VS, et al. Placenta accreta: mild cases diagnosed by placental examination. Int J Gynecol Pathol. 1996; 15(1): 28–33.
- Pron G, Mocarski E, Bennett J, et al. Ontario UFE Collaborative Group. Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial. Obstet Gynecol. 2005; 105(1): 67–76.
- Salmanian B, Fox KA, Arian SE, et al. In vitro fertilization as an independent risk factor for placenta accreta spectrum. Am J Obstet Gynecol. 2020; 223(4): 568.e1–568.e5.
- Donovan BM, Shainker SA. Placenta Accreta Spectrum. Neoreviews. 2021; 22(11): e722–e733.
