Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Santa Clara Medical Center, Santa Clara, California.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
Am J Perinatol. 2020 May;37(6):633-637. doi: 10.1055/s-0039-1685449. Epub 2019 Apr 16.
This study aimed to examine whether labor before cesarean affects the risk of placenta accreta spectrum (PAS) disorders in a subsequent pregnancy.
This is a secondary analysis of the Cesarean Registry, a prospective cohort study of women undergoing cesarean between 1999 and 2002. Women with one prior cesarean with known indications, which were categorized as likely associated with labor (labored cesarean) versus likely not associated with labor (unlabored cesarean), were included. Primary outcome was PAS disorder.
Of 34,224 women, 60% had a "labored cesarean" and 40% had an "unlabored cesarean." Women with prior unlabored cesarean were more likely to have subsequent PAS disorder compared with women with a prior labored cesarean after adjusting for confounders (0.28 vs. 0.13%; adjusted odds ratio: 2.03; 95% confidence interval: 1.22-3.38).
Prior unlabored cesarean is associated with an increased risk of PAS disorders in a subsequent pregnancy. This association may aid in risk stratification in women with suspected PAS disorders and help counsel about risks associated with cesarean on maternal request.
本研究旨在探讨剖宫产前分娩是否会增加后续妊娠胎盘植入谱系（PAS）疾病的风险。
这是对剖宫产登记处（1999 年至 2002 年进行剖宫产的前瞻性队列研究）的二次分析。纳入了既往有一次剖宫产且已知有明确适应证的女性，这些适应证分为可能与分娩相关（有分娩剖宫产）和可能与分娩无关（无分娩剖宫产）。主要结局为 PAS 疾病。
在 34224 名女性中，60%有“有分娩剖宫产”，40%有“无分娩剖宫产”。调整混杂因素后，与有分娩剖宫产史的女性相比，有剖宫产史的女性更有可能发生后续 PAS 疾病（0.28%比 0.13%；调整后的优势比：2.03；95%置信区间：1.22-3.38）。
既往无分娩剖宫产与后续妊娠 PAS 疾病风险增加相关。这种关联可能有助于对疑似 PAS 疾病的女性进行风险分层，并有助于就产妇要求行剖宫产相关风险进行咨询。
