Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing 100191, China.
Chin Med J (Engl). 2018 Mar 20;131(6):672-676. doi: 10.4103/0366-6999.226902.
Cesarean section (CS) is an independent risk factor for placenta accreta. Some researchers think that the timing of primary cesarean delivery is associated with placenta accreta in subsequent pregnancies. The aim of this study was to investigate the risk of placenta accreta following primary CS without labor, also called primary elective CS, in a pregnancy complicated with placenta previa.
: A retrospective, single-center, case-control study was conducted at Peking University Third Hospital. Relevant clinical data of singleton pregnancies between January 2010 and September 2017 were recorded. The case group included women with placenta accreta who had placenta previa and one previous CS. Control group included women with one previous CS that was complicated with placenta previa. Maternal age, body mass index, gestational age, fetal birth weight, gravity, parity, induced abortion, the rate of women received assisted reproductive technology, other uterine surgery, and primary elective CS were analyzed between the two groups.
: The rate of primary elective CS (90.1% vs. 69.9%, P < 0.001) was higher, and maternal age was younger (32.7 ± 4.7 years vs. 34.6 ± 4.0 years, P < 0.001) in case group, compared with control group. Case group also had higher gravity and induced abortions compared with the control group (both P < 0.05). Primary CS without labor was associated with significantly increased risk of placenta accreta in a subsequent pregnancy complicated with placenta previa (odds ratio: 3.32; 95% confidential interval: 1.68-6.58).
: Women with a primary elective CS without labor have a higher chance of developing an accreta in a subsequent pregnancy that is complicated with placenta previa.
剖宫产术（CS）是胎盘植入的独立危险因素。一些研究人员认为，初次剖宫产术的时机与随后妊娠的胎盘植入有关。本研究旨在探讨伴有前置胎盘的初次无临产剖宫产（也称为初次选择性剖宫产）后胎盘植入的风险。
本研究采用回顾性、单中心、病例对照研究方法，收集 2010 年 1 月至 2017 年 9 月在北京大学第三医院就诊的单胎妊娠患者的相关临床资料。病例组为前置胎盘且既往有 1 次剖宫产的胎盘植入患者；对照组为前置胎盘且既往有 1 次剖宫产的患者。分析两组患者的年龄、体重指数、孕周、胎儿出生体重、分娩方式、产次、流产史、接受辅助生殖技术的比例、其他子宫手术史、初次选择性剖宫产的比例。
病例组初次选择性剖宫产率（90.1% vs. 69.9%，P < 0.001）高于对照组，且产妇年龄更小（32.7 ± 4.7 岁 vs. 34.6 ± 4.0 岁，P < 0.001）。病例组的剖宫产次数和流产史多于对照组（均 P < 0.05）。与对照组相比，初次无临产剖宫产与前置胎盘患者后续妊娠胎盘植入的风险显著增加相关（优势比：3.32；95%置信区间：1.68-6.58）。
对于伴有前置胎盘的患者，初次无临产剖宫产可能会增加后续妊娠发生胎盘植入的风险。
