Vinograd Adi, Wainstock Tamar, Mazor Moshe, Mastrolia Salvatore Andrea, Beer-Weisel Ruthy, Klaitman Vered, Dukler Doron, Hamou Batel, Benshalom-Tirosh Neta, Vinograd Ofir, Erez Offer
School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Eur J Obstet Gynecol Reprod Biol. 2015 Apr;187:20-4. doi: 10.1016/j.ejogrb.2015.01.014. Epub 2015 Jan 23.
The rate of placenta accreta, a life threatening condition, is constantly increasing, mainly due to the rise in the rates of cesarean sections. This study is aimed to determine the effect of a history of placenta accreta on subsequent pregnancies.
A population based retrospective cohort study was designed, including all women who delivered at our medical center during the study period. The study population was divided into two groups including pregnancies with: (1) a history of placenta accreta (n=514); and (2) control group without placenta accreta (n=239,126).
(1) A history of placenta accreta is an independent risk factor for postpartum hemorrhage (adjusted OR 4.1, 95% CI 1.5-11.5) as were placenta accreta (adjusted OR 22.0, 95% CI 14.0-36.0) and placenta previa (adjusted OR 7.6, 95% CI 4.4-13.2) in the current pregnancy, and a prior cesarean section (adjusted OR 1.7, 95% CI 1.3-2.2); (2) in addition, placenta accreta in a previous pregnancy is associated with a reduced rate of mild preeclampsia in future pregnancies (1.8% vs. 3.4%, RR 0.51, 95% CI 0.26-0.98); (3) however, in spite of the higher rate of neonatal deaths in the study group, a history of placenta accreta was not an independent risk factor for total perinatal mortality (adjusted OR 1.0, 95% CI 0.5-1.9) after adjusting for confounders.
A history of placenta accreta is an independent risk factor for postpartum hemorrhage. This should be taken into account in order to ensure a safety pregnancy and delivery of these patients.
凶险性前置胎盘是一种危及生命的疾病，其发生率不断上升，主要原因是剖宫产率的增加。本研究旨在确定凶险性前置胎盘病史对后续妊娠的影响。
设计了一项基于人群的回顾性队列研究，纳入研究期间在我们医疗中心分娩的所有女性。研究人群分为两组，包括有以下情况的妊娠：（1）有凶险性前置胎盘病史（n = 514）；（2）无凶险性前置胎盘的对照组（n = 239,126）。
（1）凶险性前置胎盘病史是产后出血的独立危险因素（校正比值比4.1，95%可信区间1.5 - 11.5），当前妊娠中的凶险性前置胎盘（校正比值比22.0，95%可信区间14.0 - 36.0）、前置胎盘（校正比值比7.6，95%可信区间4.4 - 13.2）以及既往剖宫产史（校正比值比1.7，95%可信区间1.3 - 2.2）也是产后出血的独立危险因素；（2）此外，既往妊娠中的凶险性前置胎盘与未来妊娠中轻度子痫前期发生率降低相关（1.8%对3.4%，相对危险度0.51，95%可信区间0.26 - 0.98）；（3）然而，尽管研究组新生儿死亡率较高，但在调整混杂因素后，凶险性前置胎盘病史并非围产儿总死亡率的独立危险因素（校正比值比1.0，95%可信区间0.5 - 1.9）。
凶险性前置胎盘病史是产后出血的独立危险因素。为确保这些患者安全妊娠和分娩，应考虑这一因素。
