Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, UT.
Am J Obstet Gynecol. 2014 Mar;210(3):241.e1-6. doi: 10.1016/j.ajog.2013.09.044. Epub 2013 Oct 2.
Patients with suspected placenta accreta have improved outcomes with scheduled delivery. Our objective was to identify risk factors for unscheduled delivery in patients with suspected placenta accreta.
This was a cohort study of women with antenatally suspected placenta accreta. Women who delivered prior to a planned delivery date were compared with women who had a scheduled delivery. Data were analyzed using a Student t test, χ(2), logistic regression, and survival analyses. Variables included in the analyses were episodes of antenatal vaginal bleeding, preterm premature rupture of membranes (PPROM), uterine contractions, prior cesarean deliveries, interpregnancy interval, parity, and patient demographic factors. A value of P < .05 was considered significant.
Seventy-seven women with antenatal suspicion for placenta accreta were identified. Thirty-eight (49.4%) had an unscheduled delivery. Demographics were similar between groups. Unscheduled patients delivered earlier (mean 32.3 vs 35.7 weeks, P < .001) and were significantly more likely to have had vaginal bleeding (86.8% vs 35.9%, P < .001) and uterine activity (47.4% vs 2.6%, P < .001). Each episode of antenatal vaginal bleeding was associated with an increased risk of unscheduled delivery (adjusted odds ratio, 3.8; 95% confidence interval, 1.8-7.8). Risk of earlier delivery was even greater when associated with PPROM (P < .001).
Among women with suspected placenta accreta, those with antenatal vaginal bleeding were more likely to require unscheduled delivery. This risk increases further in the setting of PPROM and/or uterine contractions. These clinical factors should be considered when determining the optimal delivery gestational age for women with placental accreta.
疑似胎盘植入的患者计划性分娩可获得更好的结局。本研究旨在明确疑似胎盘植入患者中计划性分娩转为非计划性分娩的相关危险因素。
本研究为产前疑似胎盘植入患者的队列研究。将提前分娩的患者与计划分娩的患者进行比较。采用 t 检验、卡方检验、logistic 回归和生存分析对数据进行分析。纳入分析的变量包括产前阴道出血、早产胎膜早破（PPROM）、子宫收缩、既往剖宫产史、两次妊娠间隔、产次及患者的人口统计学因素。P＜0.05 认为差异有统计学意义。
共纳入 77 例产前疑似胎盘植入患者。38 例（49.4%）患者出现非计划性分娩。两组患者的人口统计学特征相似。非计划性分娩患者的分娩时间更早（平均 32.3 周 vs 35.7 周，P＜0.001），且更可能出现阴道出血（86.8% vs 35.9%，P＜0.001）和子宫活动（47.4% vs 2.6%，P＜0.001）。每次产前阴道出血均增加非计划性分娩的风险（校正比值比 3.8，95%置信区间 1.8~7.8）。若同时合并 PPROM，则分娩时间更早（P＜0.001）。
在疑似胎盘植入的患者中，产前阴道出血的患者更可能需要非计划性分娩。如果同时合并 PPROM 和/或子宫收缩，这种风险会进一步增加。在确定胎盘植入患者的最佳分娩孕周时，应考虑这些临床因素。
