Tavella Nicola Francesco, Rosenberg Henri Mitchell, Mills Alexandra, Owens Thomas, Brustman Lois, Doulaveris Georgios, Haberman Shoshana, Limaye Meghana, Janevic Teresa, Jessel Rebecca Hope, Bianco Angela Teresa
Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Obstetrics, Gynecology, and Reproductive Science, Mount Sinai West Medical Center, New York, New York, USA.
BMJ Public Health. 2024 Oct 13;2(2):e001083. doi: 10.1136/bmjph-2024-001083. eCollection 2024 Dec.
Placenta accreta spectrum (PAS) disorder is a source of severe obstetric morbidity and mortality worldwide. The objective of this paper was to evaluate the potential relationship between social vulnerability and severe maternal morbidity in a cohort of patients delivering a pregnancy complicated by PAS.
A retrospective review of 323 deliveries at three academic medical institutions between January 2013 and June 2022 was included in the analyses. Patients were those with a histopathologically confirmed case of PAS. The composite morbidity outcome included such maternal complications as mechanical ventilation, injury to organs and transfusion of 4+units of red blood cells. Social vulnerability was measured by assigning subjects a value of the Childhood Opportunity Index based on their home zip code. Logistic regression models were employed and adjusted for potential confounders.
73% of our sample experienced composite severe maternal morbidity at the time of their delivery. There were no statistically significant associations between social vulnerability and severe surgical morbidity, either as a composite or individually, within the multivariate regression models.
Our results do not support the hypothesis that social vulnerability is associated with severe maternal morbidity in deliveries complicated by PAS. The present study suggests that the relationship between social vulnerability and obstetrical surgical morbidity is more complicated than can be assessed by the present linear regression models.
胎盘植入谱系障碍（PAS）是全球严重产科发病和死亡的一个原因。本文的目的是评估在一组分娩合并PAS的患者中，社会脆弱性与严重孕产妇发病之间的潜在关系。
对2013年1月至2022年6月期间在三家学术医疗机构进行的323例分娩进行回顾性分析。患者为经组织病理学确诊为PAS的病例。综合发病结局包括机械通气、器官损伤和输注4个以上单位红细胞等孕产妇并发症。通过根据受试者的家庭邮政编码为其赋予儿童机会指数值来衡量社会脆弱性。采用逻辑回归模型并对潜在混杂因素进行校正。
我们样本中的73%在分娩时经历了综合严重孕产妇发病。在多变量回归模型中，无论是作为综合指标还是单独指标，社会脆弱性与严重手术发病之间均无统计学意义上的关联。
我们的结果不支持社会脆弱性与分娩合并PAS时严重孕产妇发病相关的假设。本研究表明，社会脆弱性与产科手术发病之间的关系比目前的线性回归模型所能评估的更为复杂。
