Department of Maternal-Fetal Medicine, University of Minnesota, Minneapolis, MN.
Care Delivery Research, Allina Health, MN.
Am J Obstet Gynecol. 2019 Oct;221(4):357.e1-357.e5. doi: 10.1016/j.ajog.2019.07.028. Epub 2019 Jul 22.
Placenta accreta spectrum affects approximately 3 in 1000 pregnancies. There is a paucity of data evaluating the effect of placental location on diagnosis, risk factors, and resultant outcomes in cases of placenta accreta spectrum.
We analyzed placenta accreta spectrum cases to assess whether risk factors or maternal outcomes varied based on placental location.
We performed a retrospective chart review of pathology-confirmed cases of placenta accreta spectrum from patients delivering at 2 large urban hospitals in the same healthcare system from 2007 to 2017. Placental location was defined by ultrasound images and confirmed by pathology reports. Location was categorized as anterior, posterior, or anterior/posterior for those with placental location at both sites. Fisher exact tests and analysis of variance were used to examine associations with measures of diagnosis, risk factors, and maternal outcomes.
A total of 86 pathology-confirmed placenta accreta spectrum cases were reviewed. The distribution of placental location on ultrasound was as follows: 19% posterior, 59% anterior, and 22% anterior/posterior. We found that prior cesarean delivery was lower with posterior placenta accreta spectrum (63% vs 94% vs 84% in the anterior and anterior/posterior groups respectively; (P = .007); however, in vitro fertilization rates were significantly higher (38% vs 2% vs 5% in the anterior and anterior/posterior groups respectively; P = .001). There was also lower incidence of percreta with posterior placenta accreta spectrum compared to the anterior and anterior/posterior groups (19% vs 47% vs 58% respectively; P = .055). Posterior cases were less likely to have placenta accreta spectrum suspected prenatally (50%) compared to anterior (80%) and anterior/posterior (89%) cases (P = .019). Despite late diagnosis, ureteral injury was the only surgical complication that was more common in patients with posterior placenta accreta spectrum (13% vs 0% vs 5% for anterior and anterior/posterior groups respectively; P = .037).
Placenta accreta spectrum with posterior placental location is associated with delayed diagnosis, surgical complications, assisted reproductive technology, and lower numbers of prior cesarean deliveries relative to anterior location. These differences in outcomes and risk factors based on placental location may allow for heightened clinical awareness, and improved diagnosis and management.
胎盘植入谱系疾病影响约每 1000 例妊娠中的 3 例。目前，关于胎盘位置对胎盘植入谱系疾病的诊断、危险因素和结果的影响，相关数据十分有限。
我们分析胎盘植入谱系疾病病例，以评估胎盘位置是否会影响危险因素或产妇结局。
我们对 2007 年至 2017 年在同一医疗系统的 2 家大型城市医院分娩的经病理证实的胎盘植入谱系疾病患者进行了回顾性图表审查。胎盘位置通过超声图像定义，并通过病理报告确认。对于胎盘位于两个部位的患者，胎盘位置分为前位、后位或前/后位。我们使用 Fisher 精确检验和方差分析来检查与诊断、危险因素和产妇结局相关的指标。
共回顾了 86 例经病理证实的胎盘植入谱系疾病病例。超声检查的胎盘位置分布如下：后位占 19%，前位占 59%，前/后位占 22%。我们发现，后位胎盘植入谱系疾病患者的既往剖宫产率较低（分别为 63%、94%和 84%；P =.007），但体外受精率显著较高（分别为 38%、2%和 5%；P =.001）。后位胎盘植入谱系疾病患者的穿透性胎盘植入发生率也低于前位和前/后位胎盘植入谱系疾病患者（分别为 19%、47%和 58%；P =.055）。后位胎盘植入谱系疾病患者产前怀疑胎盘植入的比例较低（50%），而前位（80%）和前/后位（89%）胎盘植入谱系疾病患者产前怀疑胎盘植入的比例较高（P =.019）。尽管诊断较晚，但输尿管损伤是后位胎盘植入谱系疾病患者唯一更常见的手术并发症（分别为 13%、0%和 5%；P =.037）。
与前位胎盘位置相比，后位胎盘植入谱系疾病与延迟诊断、手术并发症、辅助生殖技术和较少的既往剖宫产有关。这些基于胎盘位置的结局和危险因素的差异可能会提高临床意识，并改善诊断和管理。
