Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy.
Department of Woman, Child and of General and Specialized Surgery, University "Luigi Vanvitelli", Naples, Italy.
Acta Obstet Gynecol Scand. 2021 Mar;100 Suppl 1:41-49. doi: 10.1111/aogs.14120. Epub 2021 Mar 12.
Placenta accreta spectrum (PAS) is a condition often resulting in severe maternal morbidity. Scheduled delivery by an experienced team has been shown to improve maternal outcomes; however, the benefits must be weighed against the risk of iatrogenic prematurity. The aim of this study is to investigate the rates of emergency delivery seen for antenatally suspected PAS and compare the resulting outcomes in the 15 referral centers of the International Society for PAS (IS-PAS).
Fifteen centers provided cases between 2008 and 2019. The women included were divided into two groups according to whether they had a planned or an emergency cesarean delivery. Delivery was defined as "planned" when performed at a time and date to suit the team. All the remaining cases were classified as "emergency". Maternal characteristics and neonatal outcomes were compared between the two groups according to gestation at delivery.
In all, 356 women were included. Of these, 239 (67%) underwent a planned delivery and 117 (33%) an emergency delivery. Vaginal bleeding was the indication for emergency delivery in 41 of the 117 women (41%). There were no significant differences in terms of blood loss, transfusion rates or major maternal morbidity between planned and emergency deliveries. However, the rate of maternal intensive therapy unit admission was increased with emergency delivery (45% vs 33%, P = .02). Antepartum hemorrhage was the only independent predictor of emergency delivery (aOR: 4.3, 95% confidence interval 2.4-7.7). Emergency delivery due to vaginal bleeding was more frequent with false-positive cases (antenatally suspected but not confirmed as PAS at delivery) and the milder grades of PAS (accreta/increta). The rate of infants experiencing any major neonatal morbidity was 25% at 34 to 36 weeks and 19% at >36 weeks.
Emergency delivery in centers of excellence did not increase blood loss, transfusion rates or maternal morbidity. The single greatest risk factor for emergency delivery was antenatal hemorrhage. When adequate expertise and resources are available, to defer delivery in women with no significant antenatal bleeding and no risk factors for pre-term birth until >36 weeks can be considered to improve fetal outcomes. Further studies are needed to investigate this fully.
胎盘部位滋养细胞肿瘤谱（PAS）常导致严重的产妇发病率。经验丰富的团队计划性分娩已被证明可以改善产妇结局；然而，必须权衡这种做法对医源性早产风险的影响。本研究旨在调查产前疑似 PAS 行急诊分娩的发生率，并比较国际 PAS 学会（IS-PAS）的 15 个转诊中心的结果。
15 个中心在 2008 年至 2019 年期间提供了病例。根据是否进行计划剖宫产或急诊剖宫产，将这些女性分为两组。当分娩时间和日期适合团队时，将分娩定义为“计划”。所有其余病例均归类为“急诊”。根据分娩时的孕周，比较两组产妇特征和新生儿结局。
共纳入 356 例女性。其中，239 例（67%）行计划性剖宫产，117 例（33%）行急诊剖宫产。117 例急诊剖宫产中，41 例（41%）因阴道出血而进行急诊剖宫产。计划分娩和急诊分娩之间在出血量、输血率或主要产妇发病率方面无显著差异。然而，急诊分娩时产妇入住重症监护病房的比例较高（45% vs 33%，P = 0.02）。产前出血是急诊分娩的唯一独立预测因素（aOR：4.3，95%置信区间 2.4-7.7）。由于阴道出血而进行的急诊分娩在假阳性病例（产前疑似但分娩时未确诊为 PAS）和 PAS 较轻的病例（胎盘粘连/胎盘植入）中更为常见。胎龄为 34-36 周和>36 周时，出现任何主要新生儿并发症的婴儿发生率分别为 25%和 19%。
在卓越中心行急诊分娩不会增加出血量、输血率或产妇发病率。急诊分娩的最大危险因素是产前出血。当有足够的专业知识和资源时，对于无明显产前出血且无早产风险因素的女性，可考虑将分娩推迟至>36 周，以改善胎儿结局。需要进一步研究以充分探讨这一问题。
