Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2253349. doi: 10.1080/14767058.2023.2253349.
Induced abortion could increase the risk of placenta accreta spectrum (PAS) in the next pregnancy. We aimed to explore the associations between characteristics of previous induced abortion and grades of current PAS.
A retrospective case-control study was performed in eligible pregnant women with PAS between January 2014 and June 2022. Data collected included demographics, obstetric characteristics, and information on previous induced abortion.
The study included 211 pregnant women, with 51 and 160 in the invasive (placenta increta or percreta) and adherence (placenta creta) PAS groups, respectively. The risk of invasive PAS was 14.3-fold higher in patients with abnormal vaginal bleeding after abortion (odds ratio = 14.3, 95% confidence interval 5.6-36.4, < .01) than those without abnormal vaginal bleeding and approximately 5.8-fold higher in patients with the last induced abortion ≥5 years ago than those within 5 years (odds ratio = 5.8, 95% confidence interval 2.2-15.2, < .01). The risk of invasive PAS was 13.4-fold higher in patients with placenta attached to uterine cornu than patients with the placenta attached to uterine wall (odds ratio = 17.5, 95% confidence interval 5.5-55.5, < .01). The number of previous induced abortions, hospital grades, and gestational age at abortion were not different between two groups.
In pregnant women with a history of induced abortion, abnormal vaginal bleeding after induced abortion and prolonged duration after the last induced abortion increased the risk for invasive PAS in the current pregnancy. The number of previous induced abortions and gestational age at abortion had no relation to the grades of PAS.
人工流产可增加下一胎发生胎盘植入谱系疾病（PAS）的风险。本研究旨在探讨既往人工流产特征与当前 PAS 分级之间的相关性。
本研究为回顾性病例对照研究，纳入 2014 年 1 月至 2022 年 6 月期间患有 PAS 的孕妇。收集的数据包括人口统计学特征、产科特征以及既往人工流产信息。
共纳入 211 名孕妇，其中浸润型（胎盘植入或穿透性胎盘）和粘连型（胎盘粘连性胎盘）PAS 组分别为 51 例和 160 例。与无异常阴道出血的患者相比，流产后有异常阴道出血的患者发生浸润型 PAS 的风险高 14.3 倍（比值比=14.3，95%置信区间：5.636.4， < 0.01），且上次人工流产≥5 年前的患者发生浸润型 PAS 的风险高 5.8 倍（比值比=5.8，95%置信区间：2.215.2， < 0.01）。胎盘附着于子宫角部的患者发生浸润型 PAS 的风险比胎盘附着于子宫壁的患者高 13.4 倍（比值比=17.5，95%置信区间：5.5~55.5， < 0.01）。两组间既往人工流产次数、医院级别和流产时的孕周无差异。
对于有流产史的孕妇，人工流产后异常阴道出血和上次人工流产后时间延长会增加当前妊娠发生浸润型 PAS 的风险。既往人工流产次数和流产时的孕周与 PAS 分级无关。
