Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Peking University First Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2022 May 18;13:862785. doi: 10.3389/fendo.2022.862785. eCollection 2022.
It remained controversial whether women with multiple gestation are at higher risk of placenta accreta spectrum (PAS) disorders and large-scale studies are needed. This study aimed to assess whether PAS incidence is higher among women with multiple gestation than among singleton, as well as to compare the characteristics and outcomes of PAS in multiple and singleton gestation.
Women who underwent cesarean section with live births at Peking University First Hospital from January 2015 to December 2020 were included. Demographic and clinical information was collected through chart review. Logistic regression models were used to analyze the associations between multiple gestation and PAS. The clinical characteristics and perioperative outcomes of PAS in multiple and singleton gestation were further compared.
Among the 14583 women included, 2.4% (352/14583) were diagnosed with PAS. PAS was slightly more prevalent among multiple gestations than among singletons (2.5% vs 2.4%, =0.857). After adjusting for known risk factors and pregnancy complications, multiple gestation was associated with a higher risk of PAS (a=1.63, 95% 1.01-2.62). Among PAS patients, women who had multiple births had a significantly lower rate of previous cesarean deliveries (27.6% vs. 56.3%, =0.003), placenta previa (17.2% vs. 56.3%, <0.001) and invasive PAS (24.1% vs. 53.9, =0.002) than singletons. There were no significant differences in perioperative outcomes between these two groups.
Multiple gestation could be independently associated with an elevated risk of PAS. The clinical characteristics of PAS in the multiple and singleton gestation groups differed significantly in cesarean delivery history and placenta previa. The results of this study may inform guidelines on the screening, early detection and timely intervention of PAS patients among women with multiple births.
多胎妊娠的女性是否更容易发生胎盘植入谱系（PAS）疾病仍存在争议，需要进行大规模研究。本研究旨在评估多胎妊娠女性的 PAS 发病率是否高于单胎妊娠女性，并比较多胎和单胎妊娠 PAS 的特征和结局。
本研究纳入了 2015 年 1 月至 2020 年 12 月期间在北京大学第一医院行剖宫产分娩活产的女性。通过病历回顾收集人口统计学和临床信息。采用 logistic 回归模型分析多胎妊娠与 PAS 的关系。进一步比较多胎和单胎妊娠 PAS 的临床特征和围手术期结局。
在纳入的 14583 名女性中，352 名（2.4%）诊断为 PAS。多胎妊娠 PAS 的发生率略高于单胎妊娠（2.5% vs 2.4%，=0.857）。调整已知危险因素和妊娠并发症后，多胎妊娠与 PAS 风险增加相关（a=1.63，95%CI 1.01-2.62）。在 PAS 患者中，多胎分娩的女性既往剖宫产率明显较低（27.6% vs 56.3%，=0.003），前置胎盘（17.2% vs 56.3%，<0.001）和侵袭性 PAS（24.1% vs 53.9%，<0.001）发生率也较低。两组患者的围手术期结局无显著差异。
多胎妊娠可能与 PAS 风险升高独立相关。多胎和单胎妊娠 PAS 患者在剖宫产史和前置胎盘方面的临床特征存在显著差异。本研究结果可为多胎妊娠女性 PAS 患者的筛查、早期发现和及时干预提供依据。
