Fan Dazhi, Li Song, Wu Shuzhen, Wang Wen, Ye Shaoxin, Xia Qing, Liu Li, Feng Jinping, Wu Song, Guo Xiaoling, Liu Zhengping
aFoshan Institute of Fetal Medicine bDepartment of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong cDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei dChaohu Hospital Affiliated Anhui Medical University, Chaohu, Anhui eDepartment of Library, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang fSchool of Integrated Traditional and Western Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China.
Medicine (Baltimore). 2017 Apr;96(16):e6636. doi: 10.1097/MD.0000000000006636.
Abnormally invasive placenta (AIP) or placenta accreta (PA) is considered numerous adverse maternal and fetal-neonatal complications. There has been no detailed study to characterize the prevalence of AIP among deliveries in mainland China.
We aimed to fill this gap and obtained overall and regional estimates of AIP prevalence via a systematic review and meta-analysis.
This systematic review and meta-analysis was totally performed following the Meta-analysis of Observational Studies in Epidemiology guidelines for systematic reviews of observational studies, and the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement for reporting systematic reviews and meta-analysis.
A total of 23 articles (including 350,939) were included. Most studies (22) focused on the placenta increta (PI), only 2 articles in PA, and none in placenta percreta (PP). In this meta-analysis, the overall prevalence of AIP was 0.22% (95% confidence interval 0.18%-0.27%) in a heterogeneous set of studies (I = 93.5%). In a subgroup, the prevalence of PA and PI was 0.48% and 0.23%, respectively. Stratified analyses of PI found that the prevalence was similar in North (0.23% [0.14%-0.32%]) and South (0.23% [0.15%-0.32%]), and lower in Central (0.20% [0.09-0.31%]); the inlanders (0.17% (0.12%-0.23%]) had a lower prevalence of PI than those living in coastal areas (0.24% [0.35%-0.63%]). As time goes on, the prevalence, from 0.03% (0.02%-0.04%) in 1970 to 1979 to 0.48% (0.30%-0.66%) in 2010 to present, was higher and higher. The different prevalence was also found in different in maternal age groups.
This first systematic review and meta-analysis found that the prevalence differed among different geographic areas and maternal age groups. The results would be useful for the design of abnormally invasive placenta planning and implementation adequate health care systems and treatment programs in mainland China.
异常侵袭性胎盘（AIP）或胎盘植入（PA）被认为会引发众多不良母婴及胎儿-新生儿并发症。目前尚无详细研究描述中国大陆分娩中AIP的患病率。
我们旨在填补这一空白，通过系统评价和荟萃分析获得AIP患病率的总体及区域估计值。
本系统评价和荟萃分析完全按照流行病学观察性研究的荟萃分析指南进行系统评价，以及按照系统评价和荟萃分析的首选报告项目声明进行系统评价和荟萃分析报告。
共纳入23篇文章（包括350,939例）。大多数研究（22篇）聚焦于胎盘植入（PI），仅有2篇关于PA的文章，无关于穿透性胎盘植入（PP）的文章。在这项荟萃分析中，在一组异质性研究（I = 93.5%）中，AIP的总体患病率为0.22%（95%置信区间0.18%-0.27%）。在一个亚组中，PA和PI的患病率分别为0.48%和0.23%。对PI的分层分析发现，北方（0.23% [0.14%-0.32%]）和南方（0.23% [0.15%-0.32%]）的患病率相似，中部地区较低（0.20% [0.09-0.31%]）；内陆地区居民（0.17% [0.12%-0.23%]）的PI患病率低于沿海地区居民（0.24% [0.35%-0.63%]）。随着时间推移，患病率从1970年至1979年的0.03%（0.02%-0.04%）上升至2010年至今的0.48%（0.30%-0.66%），且越来越高。在不同年龄组的产妇中也发现了不同的患病率。
这项首次系统评价和荟萃分析发现，患病率在不同地理区域和产妇年龄组中存在差异。这些结果将有助于中国大陆设计异常侵袭性胎盘的规划，并实施适当的医疗保健系统和治疗方案。
