Zeevi Gil, Tirosh Dan, Baron Joel, Sade Maayan Yitshak, Segal Adi, Hershkovitz Reli
US Unit, Department of Obstetrics and Gynecology, Ben Gurion University of the Negev, Beer Sheva, Israel.
Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Arch Gynecol Obstet. 2018 May;297(5):1151-1156. doi: 10.1007/s00404-018-4698-4. Epub 2018 Feb 5.
To (a) evaluate the risk for placenta accreta following primary cesarean section (CS), in regard to the stage of labor, the cesarean section was taken (elective prelabor vs. unplanned during labor); and (b) investigate whether the association between placenta accreta and maternal and neonatal complications is modified by the type of the primary CS.
In a population-based retrospective cohort study, we included all singleton deliveries occurred in Soroka University Medical Center between 1991 and 2015, of women who had a history of a single CS. The deliveries were divided into three groups according to the delivery stage the primary CS was carried out: 'Unplanned 1' (first stage-up to 10 cm), 'Unplanned 2' (second stage-10 cm) and 'Elective' prelabor CS. We assessed the association between the study group and placenta accreta using logistic generalized estimation equation (GEE) models. We additionally assessed maternal and neonatal complications associated with placenta accreta among women who had elective and unplanned CS separately.
We included 22,036 deliveries to 13,727 women with a history of one CS, of which 0.9% (n = 207) had placenta accreta in the following pregnancies: 12% (n = 25) in the 'Unplanned 1' group, 7.2% (n = 15) in the ' Unplanned 2' group and 80.8% (n = 167) in the 'elective' group. We found no difference in the risk for subsequent placenta accreta between the groups. In a stratified analysis by the timing of the primary cesarean delivery, the risk for maternal complications, associated with placenta accreta, was more pronounced among women who had an unplanned CS (OR 27.96, P < 0.01) compared to women who had an elective cesarean delivery (OR 13.72, P < 0.01).
The stage in which CS is performed has no influence on the risk for placenta accreta in the following pregnancies, women who had an unplanned CS are in a higher risk for placenta accrete-associated maternal complications. This should be taken into consideration while counselling women about their risk while considering trial of labor after cesarean section.
(a) 评估初次剖宫产（CS）后胎盘植入的风险，考虑分娩阶段（剖宫产是选择性的产前剖宫产还是分娩期间的非计划剖宫产）；(b) 研究初次剖宫产类型是否会改变胎盘植入与孕产妇和新生儿并发症之间的关联。
在一项基于人群的回顾性队列研究中，我们纳入了1991年至2015年间在索罗卡大学医学中心发生的所有单胎分娩，这些产妇有过一次剖宫产史。根据初次剖宫产的分娩阶段，将分娩分为三组：“非计划1组”（第一产程——宫口开大至10厘米）、“非计划2组”（第二产程——宫口开大10厘米）和“选择性”产前剖宫产组。我们使用逻辑广义估计方程（GEE）模型评估研究组与胎盘植入之间的关联。我们还分别评估了选择性剖宫产和非计划剖宫产的女性中与胎盘植入相关的孕产妇和新生儿并发症。
我们纳入了13727名有过一次剖宫产史的女性的22036例分娩，其中0.9%（n = 207）在随后的妊娠中发生了胎盘植入：“非计划1组”中为12%（n = 25），“非计划2组”中为7.2%（n = 15），“选择性”组中为80.8%（n = 167）。我们发现各组之间后续胎盘植入的风险没有差异。在按初次剖宫产时间进行的分层分析中，与胎盘植入相关的孕产妇并发症风险在非计划剖宫产的女性中（OR 27.96，P < 0.01）比选择性剖宫产的女性中（OR 13.72，P < 0.01）更为明显。
剖宫产的阶段对后续妊娠中胎盘植入的风险没有影响，非计划剖宫产的女性发生胎盘植入相关孕产妇并发症的风险更高。在为考虑剖宫产术后试产的女性提供风险咨询时应考虑到这一点。
