Trousseau Hospital, APHP, Sorbonne University, Paris, France.
CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.
BJOG. 2021 Sep;128(10):1646-1655. doi: 10.1111/1471-0528.16647. Epub 2021 Feb 3.
To describe and compare the characteristics of women with placenta accreta spectrum (PAS) and their pregnancy outcomes according to the presence of placenta praevia and a prior caesarean section.
Prospective population-based study.
All 176 maternity hospitals of eight French regions.
Two hundred and forty-nine women with PAS, from a source population of 520 114 deliveries.
Women with PAS were classified into two risk-profile groups, with or without the high-risk combination of placenta praevia (or an anterior low-lying placenta) and at least one prior caesarean. These two groups were described and compared.
Population-based incidence of PAS, characteristics of women, pregnancies, deliveries and pregnancy outcomes.
The PAS population-based incidence was 4.8/10 000 (95% CI 4.2-5.4/10 000). After exclusion of women lost to follow up from the analysis, the group with placenta praevia and a prior caesarean included 115 (48%) women and the group without this combination included 127 (52%). In the group with both factors, PAS was more often suspected antenatally (77% versus 17%; P < 0.001) and more often percreta (38% versus 5%; P < 0.001). This group also had more hysterectomies (53% versus 21%, P < 0.001) and higher rates of blood product transfusions, maternal complications, preterm births and neonatal intensive care unit admissions. Sensitivity analysis showed similar results after exclusion of women who delivered vaginally.
More than half the cases of PAS occurred in women without the combination of placenta praevia and a prior caesarean delivery, and these women had better maternal and neonatal outcomes. We cannot completely rule out that some of the women who delivered vaginally had placental retention rather than PAS; however, we found similar results among women who delivered by caesarean.
Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes.
根据前置胎盘和剖宫产史的存在情况，描述和比较胎盘植入谱系（PAS）女性的特征及其妊娠结局。
前瞻性基于人群的研究。
法国 8 个地区的所有 176 家产科医院。
520114 例分娩产妇中，249 例 PAS 患者。
将 PAS 患者分为有或无高危因素（前置胎盘或前壁低位胎盘和至少一次剖宫产）的两个风险特征组。对这两组进行描述和比较。
基于人群的 PAS 发生率、患者特征、妊娠、分娩和妊娠结局。
基于人群的 PAS 发生率为 4.8/10000（95%CI 4.2-5.4/10000）。排除分析中失访的患者后，有前置胎盘和剖宫产史的组包括 115 例（48%）患者，无此组合的组包括 127 例（52%）患者。在有两个因素的组中，PAS 更常被产前怀疑（77%比 17%；P<0.001）且更常为胎盘穿透（38%比 5%；P<0.001）。该组还进行了更多的子宫切除术（53%比 21%，P<0.001），并出现更多的输血、产妇并发症、早产和新生儿重症监护病房入住率。敏感性分析显示，排除阴道分娩的患者后，结果相似。
超过一半的 PAS 病例发生在无前置胎盘和剖宫产史的女性中，这些女性的母婴结局更好。我们不能完全排除阴道分娩的部分女性为胎盘残留而非 PAS；然而，我们在剖宫产的女性中发现了相似的结果。
一半的 PAS 患者没有前置胎盘和剖宫产史，且她们的母婴结局更好。
