Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel.
Am J Obstet Gynecol. 2013 Mar;208(3):219.e1-7. doi: 10.1016/j.ajog.2012.12.037. Epub 2013 Jan 8.
We sought to evaluate risk factors and perinatal outcomes of pregnancies complicated with placenta accreta and to study perinatal outcomes in subsequent pregnancies.
A retrospective study comparing all singleton cesarean deliveries (CD) of women with and without placenta accreta was conducted. In addition, a retrospective comparison of all subsequent singleton CD of women with a previous placenta accreta, with CD of women with no such history, was performed during the years 1988 through 2011. Stratified analysis using multiple logistic regression models was performed to control for confounders.
During the study period, there were 34,869 CD, of which 0.4% (n = 139) were complicated with placenta accreta. Using a multivariable analysis with backward elimination, year of birth (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.03-1.09; P < .001), previous CD (aOR, 5.11; 95% CI, 3.42-7.65; P < .001), and placenta previa (aOR, 50.75; 95% CI, 35.57-72.45; P < .001) were found to be independently associated with placenta accreta. There were 30 subsequent pregnancies of women with placenta accreta. Recurrent accreta occurred in 4 patients (13.3%). Previous placenta accreta was significantly associated with uterine rupture (3.3% vs 0.3%, P < .01) peripartum hysterectomy (3.3% vs 0.2%, P < .001), and the need for blood transfusions (16.7% vs 4%, P < .001). Nevertheless, increased risk for adverse perinatal outcomes such as low Apgar scores at 1 and 5 minutes and perinatal mortality was not found in these patients.
Prior CD and placenta previa are independent risk factors for placenta accreta. A pregnancy following a previous placenta accreta is at increased risk for adverse maternal outcomes such as recurrent accreta, uterine rupture, and peripartum hysterectomy. However, adverse perinatal outcomes were not demonstrated.
我们旨在评估胎盘植入的风险因素和围产结局，并研究其后续妊娠的围产结局。
本研究为回顾性队列研究，比较了所有伴有和不伴有胎盘植入的单胎剖宫产（CD）产妇。此外，我们还对 1988 年至 2011 年期间所有有前置胎盘病史的胎盘植入患者的后续单胎 CD 进行了回顾性比较，并与无此类病史的 CD 患者进行了比较。采用多因素逻辑回归模型进行分层分析以控制混杂因素。
在研究期间，共有 34869 例 CD，其中 0.4%（n=139）为胎盘植入。采用逐步向后消除的多变量分析，发现产妇的出生年份（校正优势比[aOR]，1.06；95%置信区间[CI]，1.03-1.09；P<.001）、既往 CD（aOR，5.11；95%CI，3.42-7.65；P<.001）和前置胎盘（aOR，50.75；95%CI，35.57-72.45；P<.001）与胎盘植入独立相关。有 30 例胎盘植入患者的后续妊娠。4 例（13.3%）患者出现复发性植入。前置胎盘与子宫破裂（3.3%比 0.3%，P<.01）、围生期子宫切除术（3.3%比 0.2%，P<.001）和输血需求（16.7%比 4%，P<.001）显著相关。然而，这些患者并未出现低 Apgar 评分 1 分钟和 5 分钟及围生儿死亡率等不良围产结局风险增加的情况。
既往 CD 和前置胎盘是胎盘植入的独立危险因素。前置胎盘病史的患者再次妊娠时，其母体不良结局（如复发性植入、子宫破裂和围生期子宫切除术）的风险增加。然而，并未出现不良围产结局。
