Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
Arch Gynecol Obstet. 2022 Mar;305(3):607-615. doi: 10.1007/s00404-021-06189-2. Epub 2021 Aug 26.
To clarify risk factors and clinical outcomes for placenta accreta spectrum (PAS) stratified by placenta previa.
We conducted registry-based multicenter cross-sectional study including 472,301 singleton deliveries between 2013 and 2015. PAS was considered as a primary outcome, as well as maternal age, parity, history of cesarean section, history of miscarriage, and assisted reproductive technology (ART) were considered as potential exposures. A multivariable Poisson regression analysis was conducted to assess the risk for PAS, stratified by placenta previa. In addition, the risk for subsequent blood transfusion and hysterectomy by each exposure using multivariable Poisson regression analysis was conducted.
There were 426 and 1827 cases of PAS with and without placenta previa. Among cases with placenta previa, the number of previous cesarean sections was the most powerful predictor for PAS [adjusted risk ratio (aRR) for one previous cesarean section 5.34, 95% confidence interval (CI) 3.70-7.71; aRR for two or more previous cesarean section 16.5, 95% CI 11.5-23.6]. Among cases without placenta previa, previous cesarean section was not a significant predictor, whereas the strongest predictor was conception through ART (aRR 5.05, 95% CI 4.50-5.66). Although the risks of PAS for blood transfusion and hysterectomy were higher among cases with placenta previa, those without placenta previa also demonstrated non-negligible risks.
The current study demonstrated that history of cesarean section was the strongest risk factor for PAS among women with placenta previa. Among those without placenta previa, ART was an important predictor, but not cesarean section.
根据胎盘前置情况对胎盘植入谱系（PAS）的风险因素和临床结局进行分层。
我们进行了一项基于注册的多中心横断面研究，纳入了 2013 年至 2015 年间的 472301 例单胎分娩。PAS 被视为主要结局，产妇年龄、产次、剖宫产史、流产史和辅助生殖技术（ART）被视为潜在暴露因素。采用多变量泊松回归分析评估 PAS 的风险，并按胎盘前置情况进行分层。此外，还采用多变量泊松回归分析评估了每种暴露因素导致随后输血和子宫切除的风险。
有 426 例和 1827 例 PAS 病例分别伴有和不伴有胎盘前置。在伴有胎盘前置的病例中，既往剖宫产次数是 PAS 的最强预测因素[一次剖宫产的调整风险比（aRR）为 5.34，95%置信区间（CI）为 3.70-7.71；两次或更多次剖宫产的 aRR 为 16.5，95%CI 为 11.5-23.6]。在不伴有胎盘前置的病例中，既往剖宫产不是显著的预测因素，而最强的预测因素是通过 ART 受孕（aRR 为 5.05，95%CI 为 4.50-5.66）。尽管伴有胎盘前置的 PAS 患者输血和子宫切除的风险较高，但不伴有胎盘前置的患者也存在不可忽视的风险。
本研究表明，对于有胎盘前置的女性，剖宫产史是 PAS 的最强危险因素。对于没有胎盘前置的女性，ART 是一个重要的预测因素，但不是剖宫产。
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