Liang Yingyu, Zhang Lizi, Bi Shilei, Chen Jingsi, Zeng Shanshan, Huang Lijun, Li Yulian, Huang Minshan, Tan Hu, Jia Jinping, Wen Suiwen, Wang Zhijian, Cao Yinli, Wang Shaoshuai, Xu Xiaoyan, Feng Ling, Zhao Xianlan, Zhao Yangyu, Zhu Qiying, Qi Hongbo, Zhang Lanzhen, Li Hongtian, Du Lili, Chen Dunjin
Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510510, China.
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Matern Fetal Med. 2022 Feb 2;4(3):179-185. doi: 10.1097/FM9.0000000000000142. eCollection 2022 Jul.
To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA).
This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta.
For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% . 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% . 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% . 4/869, 0.46%), puerperal infection (33/10,205, 0.32% . 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% . 16/869, 1.84%), hysterectomy (130/10,205, 1.27% . 59/869, 6.79%), and blood transfusion (328/10,205,3.21% . 231/869,26.58%) was significantly increased in the PA group ( < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00-3520.00) g . 2920.00 (2530.00-3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% . 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% . 210/869, 24.17%) also increased significantly ( < 0.05). Weight (odds ratio () = 1.03, 95% confidence interval (): 1.01-1.05)), parity ( = 1.18, 95%: 1.03-1.34), number of miscarriages ( = 1.31, 95%: 1.17-1.47), number of previous cesarean sections ( = 2.57, 95%: 2.02-3.26), history of premature rupture of membrane ( = 1.61, 95%: 1.32-1.96), previous cesarean-section transverse incisions ( = 1.38, 95%: 1.12-1.69), history of placenta previa ( = 2.44,95%: 1.50-3.96), and the combination of prenatal hemorrhage ( = 9.95,95%: 8.42-11.75) and placenta previa ( = 91.74, 95%: 74.11-113.56) were all independent risk factors for PA.
There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.
探讨有剖宫产史并发胎盘植入（PA）的女性的危险因素及妊娠结局。
本病例对照研究纳入了2017年1月至2017年12月期间中国七个省份11家公立三级医院中有剖宫产史的单胎母亲的临床资料。根据分娩后术中所见，将研究人群分为PA组和非PA组。我们比较了两组的妊娠结局，采用多因素logistic回归分析胎盘植入的危险因素。
本研究共纳入11074例有剖宫产史的孕妇；其中，PA组869例，非PA组10205例。与非PA组相比，PA组产后出血（236/10205，2.31%对283/869，32.57%）、严重产后出血（89/10205，0.87%对186/869，21.75%）、弥散性血管内凝血（3/10205，0.03%对4/869，0.46%）、产褥感染（33/10205，0.32%对12/869，1.38%）、术中膀胱损伤（1/10205，0.01%对16/869，1.84%）、子宫切除术（130/10205，1.27%对59/869，6.79%）及输血（328/10205，3.21%对231/869，26.58%）的概率均显著增加（P<0.05）。同时，PA组新生儿出生体重（3250.00（2950.00 - 3520.00）g对2920.00（2530.00 - 3250.00）g）、新生儿合并症概率（245/10205，2.40%对61/869，7.02%）及新生儿重症监护病房入住率（817/10205，8.01%对210/869，24.17%）也显著增加（P<0.05）。体重（比值比（OR）=1.03，95%置信区间（CI）：1.01 - 1.05）、产次（OR = 1.18，95%CI：1.03 - 1.34）、流产次数（OR = 1.31，95%CI：1.17 - 1.47）、既往剖宫产次数（OR = 2.57，95%CI：2.02 - 3.26）、胎膜早破史（OR = 1.61，95%CI：1.32 - 1.96）、既往剖宫产横切口（OR = 1.38，95%CI：1.12 - 1.69）、前置胎盘史（OR = 2.44，95%CI：1.50 - 3.96）以及产前出血（OR = 9.95，95%CI：8.42 - 11.75）与前置胎盘并存（OR = 91.74，95%CI：74.11 - 113.56）均为PA的独立危险因素。
有剖宫产史的孕妇并发PA时不良结局风险增加，需临床密切关注。孕前体重、产次、流产次数、既往剖宫产次数、胎膜早破史、既往剖宫产横切口、前置胎盘史、产前出血及前置胎盘是有剖宫产史孕妇并发PA妊娠的独立危险因素。这些独立危险因素在预测有剖宫产史孕妇胎盘植入风险方面具有较高价值。
