Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St. Leonards, New South Wales, the Biostatistics Training Program, New South Wales Ministry of Health, North Sydney, Sydney Medical School Northern, University of Sydney, New South Wales, the Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St. Leonards, New South Wales, the School of Public Health and Community Medicine, UNSW Sydney, New South Wales, and the Sydney School of Public Health, University of Sydney, New South Wales, Australia.
Obstet Gynecol. 2018 Feb;131(2):227-233. doi: 10.1097/AOG.0000000000002434.
To evaluate the association between prior invasive gynecologic procedures and the risk of subsequent abnormally invasive placenta (ie, placenta accreta, increta, and percreta).
We conducted a population-based data linkage study including all primiparous women who delivered in New South Wales, Australia, between 2003 and 2012. Data were obtained from linked birth and hospital admissions with a minimum lookback period of 2 years. Prior procedures invasive of the uterus were considered including gynecologic laparoscopy with instrumentation of the uterus; hysteroscopy, including operative hysteroscopy; curettage, including suction curettage and surgical termination; and endometrial ablation. Modified Poisson regression was used to determine the association between the number of prior gynecologic procedures and risk of abnormally invasive placenta.
Eight hundred fifty-four cases of abnormally invasive placenta were identified among 380,775 deliveries included in the study (22.4/10,000). In total, 33,296 primiparous women had at least one prior procedure (8.7%). Among women with abnormally invasive placenta, 152 (17.8%) had undergone at least one procedure compared with 33,144 (8.7%) among women without abnormally invasive placenta (P<.01). After adjustment, the relative risk was 1.5 for one procedure (99% CI 1.1-1.9), 2.7 for two procedures (99% CI 1.7-4.4), and 5.1 for three or more procedures (99% CI 2.7-9.6). Abnormally invasive placenta was also positively associated with maternal age, socioeconomic advantage, mother being Australia-born, placenta previa, hypertension, multiple births, use of assisted reproductive technology, and female fetal sex.
Women with a history of prior invasive gynecologic procedures were more likely to develop abnormally invasive placenta. These insights may be used to inform management of pregnancies in women with a history of gynecologic procedures.
评估既往妇科侵入性操作与异常侵袭性胎盘（即胎盘植入、胎盘穿透和胎盘穿透）风险之间的关联。
我们进行了一项基于人群的数据关联研究，纳入了 2003 年至 2012 年期间在澳大利亚新南威尔士州分娩的所有初产妇。数据来自与至少 2 年回溯期的关联分娩和住院记录。既往子宫内侵入性操作包括妇科腹腔镜检查伴子宫器械操作、宫腔镜检查（包括手术性宫腔镜检查）、刮宫术（包括吸刮术和手术性终止妊娠）和子宫内膜消融术。采用校正泊松回归分析确定既往妇科操作次数与异常侵袭性胎盘风险之间的关系。
研究共纳入 380775 例分娩病例，其中 854 例诊断为异常侵袭性胎盘（22.4/10000）。共有 33296 例初产妇至少进行过一次操作（8.7%）。在异常侵袭性胎盘患者中，152 例（17.8%）至少进行过一次操作，而在无异常侵袭性胎盘患者中，33144 例（8.7%）至少进行过一次操作（P<.01）。校正后，一次操作的相对风险为 1.5（99%可信区间 1.1-1.9），两次操作的相对风险为 2.7（99%可信区间 1.7-4.4），三次或更多次操作的相对风险为 5.1（99%可信区间 2.7-9.6）。异常侵袭性胎盘也与产妇年龄、社会经济优势、母亲为澳大利亚出生、前置胎盘、高血压、多胎妊娠、辅助生殖技术应用和女性胎儿性别呈正相关。
既往有妇科侵入性操作史的妇女发生异常侵袭性胎盘的风险更高。这些发现可用于指导有妇科操作史的妇女妊娠管理。
