Department of Obstetrics and Gynecology, Geisinger Health System, Danville, USA.
Department of Obstetrics and Gynecology, Geisinger Health System, Danville, USA.
Placenta. 2020 Sep 15;99:189-192. doi: 10.1016/j.placenta.2020.08.004. Epub 2020 Aug 6.
Maternal risk factors associated with placenta previa are well documented in the literature. However, there are limited studies identifying maternal characteristics associated with the persistence of placenta previa. The objective of the study was to determine maternal characteristics associated with the persistent placenta previa.
A retrospective cohort study was conducted in which 705 pregnant women diagnosed with low-lying placenta or placenta previa between 17 and 24 weeks gestation were identified from a single institution between 2003 and 2017. The primary outcome included persistent placenta previa (i.e., persistent placental tissue within 2 cm of the internal os) at or after 36 weeks 0 days. Those with abnormal placentation (e.g., vasa previa, placenta accreta) or delivery prior to 36 weeks 0 days were excluded. Multivariable logistic regression modeling was utilized to determine significant maternal characteristics associated with persistent placenta previa among women diagnosed with either placenta previa or low-lying placenta.
Women with a prior cesarean delivery were seven times more likely to have persistent placenta previa (odds ratio, 7.0, 95% confidence interval, 3.7-13.1). A history of intrauterine curettage or evacuation in the setting of placenta previa increases the likelihood of persistent placenta previa almost 3-fold (odds ratio, 2.5, 95% confidence interval, 1.3-5.0).
To date, our study is the largest, retrospective cohort study assessing maternal risk factors associated with persistent placenta previa; and is the first to detect a statistically significant correlation between a history of intrauterine surgeries and persistent placenta previa.
与前置胎盘相关的母体危险因素在文献中有详细记载。然而，只有有限的研究确定了与前置胎盘持续存在相关的母体特征。本研究的目的是确定与持续性前置胎盘相关的母体特征。
这是一项回顾性队列研究，在 2003 年至 2017 年期间，从一家医疗机构中确定了 705 名在 17 至 24 周时被诊断为低位胎盘或前置胎盘的孕妇。主要结局包括在 36 周 0 天或之后存在持续性前置胎盘（即胎盘组织距宫颈内口 2cm 以内）。排除存在异常胎盘（例如帆状胎盘、胎盘植入）或在 36 周 0 天之前分娩的孕妇。利用多变量逻辑回归模型来确定在被诊断为前置胎盘或低位胎盘的孕妇中与持续性前置胎盘相关的显著母体特征。
有剖宫产史的女性发生持续性前置胎盘的可能性是没有剖宫产史的女性的 7 倍（优势比，7.0，95%置信区间，3.7-13.1）。在前置胎盘的情况下，有宫内刮宫术或清宫术史的孕妇发生持续性前置胎盘的可能性几乎增加 3 倍（优势比，2.5，95%置信区间，1.3-5.0）。
到目前为止，我们的研究是评估与持续性前置胎盘相关的母体危险因素的最大规模、回顾性队列研究，也是第一个检测到宫内手术史与持续性前置胎盘之间存在统计学显著相关性的研究。
