Abotorabi Shokoh, Chamanara Solmaz, Oveisi Sonia, Rafiei Maryam, Amini Leila
Department of Obstetrics and Gynecology, Clinical Research Development Unit, Kosar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.
Department of Pediatrics, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
J Family Reprod Health. 2021 Dec;15(4):229-235. doi: 10.18502/jfrh.v15i4.7888.
Placenta Accreta Spectrum (PAS) affects approximately one in a thousand deliveries. Very few studies evaluated PAS risk factors based on their location. In this study, we have investigated the effects of placenta location on placental adhesion-related complications, its risk factors, and outcomes. We performed a retrospective cohort study of pathology-confirmed cases of PAS from patients with peripartum hysterectomy, at a large educational hospital in Qazvin, Iran, from 2009 to 2019. Placenta location was found by ultrasound reports and intraoperative evaluation. We measured demographic features, basic characteristics, maternal and neonatal outcomes based on placental location including anterior, posterior, and lateral in Placenta Accreta Spectrum. Chi-square, t-test, and one-way ANOVA were used to examine the relation of complications, risk factors, and outcomes in PAS. A review of 70 cases showed the distribution of placenta location as follows: 57% anterior, 27% posterior, and 16% lateral. The mean gestational age at delivery was 35 (33-39) weeks. In 78.6% (n=55) of the patients, an association with placenta previa and in 94/2% (n=66) of cases a history of cesarean section was found, however, it was not significantly correlated with placenta location (p=0.082). We found that surgery duration was significantly longer in patients with lateral PAS (155±38, vs 129.35±33.8 and 133.15±31.5 for anterior and posterior placenta respectively, p=0.09). Patients with lateral PAS also bled more than the remaining two groups (2836 ml for lateral PAS vs 2002 and 1847 for anterior and posterior placenta respectively, p=0.022). Moreover, women with a history of uterine surgery were more likely to have posterior PAS compared to those with anterior and lateral PAS (p=0.035). Differences in complications, risk factors, and outcomes of PAS based on placenta location may lead to improved diagnosis and decreased morbidity in women.
胎盘植入谱系疾病（PAS）影响着约千分之一的分娩。很少有研究根据胎盘位置评估PAS的危险因素。在本研究中，我们调查了胎盘位置对胎盘粘连相关并发症、其危险因素及结局的影响。我们对2009年至2019年期间伊朗加兹温一家大型教学医院因产后子宫切除术确诊为PAS的患者进行了回顾性队列研究。通过超声报告和术中评估确定胎盘位置。我们根据胎盘植入谱系疾病中胎盘的位置（包括前位、后位和侧位）测量了人口统计学特征、基本特征、孕产妇和新生儿结局。采用卡方检验、t检验和单因素方差分析来研究PAS中并发症、危险因素和结局之间的关系。对70例病例的回顾显示胎盘位置分布如下：前位占57%，后位占27%，侧位占16%。分娩时的平均孕周为35（33 - 39）周。在78.6%（n = 55）的患者中发现与前置胎盘有关，在94.2%（n = 66）的病例中有剖宫产史，然而，这与胎盘位置无显著相关性（p = 0.082）。我们发现侧位PAS患者的手术时间明显更长（分别为155±38分钟，前位胎盘和后位胎盘分别为129.35±33.8分钟和133.15±31.5分钟，p = 0.09）。侧位PAS患者的出血量也比其余两组更多（侧位PAS为2836毫升，前位胎盘和后位胎盘分别为2002毫升和1847毫升，p = 0.022）。此外，有子宫手术史的女性相比前位和侧位PAS患者更易发生后位PAS（p = 0.035）。基于胎盘位置的PAS并发症、危险因素和结局的差异可能会改善对女性的诊断并降低发病率。
