Risk Factors for Placenta Accreta: A Large Prospective Cohort

Abstract

Objective Placenta previa and prior cesarean delivery are known risk factors for placenta accreta. However, other risk factors have not been identified. Our objective was to examine risk factors for accreta using data collected prospectively in a large multicenter cohort.

Study Design Secondary analysis of women with accreta compared to those without accreta in a large multicenter cesarean delivery cohort. Potential accreta risk factors were examined by univariate and multivariate analyses.

Results In this study, 196 of 73,257 (0.27%) cesarean deliveries were complicated by accreta. As expected, women with increasing numbers of prior cesareans were more likely to have an accreta (p < 0.001), as were women with previa (adjusted odds ratio [OR], 34.9; 95% confidence interval [CI], 22.4–54.3). We also considered only patients with previa and examined the following variables: maternal demographics, prior cesareans, interval between deliveries, parity, body mass index, tobacco use, and coexisting hypertension or diabetes. In this model, patients with previa and two or three prior cesarean deliveries had an adjusted OR for accreta of 4.9 (95% CI, 1.7–14.3) or 7.7 (95% CI, 2.4–24.9), respectively. However, no other variables were significantly associated with accreta.

Conclusion Patients with previa have increased risk for accreta that increases with the number of prior cesarean deliveries. However, no other maternal characteristics were associated with accreta.

Keywords

placenta accreta - cesarean delivery - placenta previa - risk factors

Note

The title “Risk factors for the development of placenta accreta” was presented at The Society for Gynecologic Investigation 60th Annual Meeting in Orlando, FL, March 23, 2013 (Abstract #S-189).

• References

• 1 Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 2006; 107 (4) 927-941
• 2 Silver RM, Landon MB, Rouse DJ , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107 (6) 1226-1232
• 3 Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177 (1) 210-214
• 4 Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985; 66 (1) 89-92
• 5 MacDorman M, Declercq E, Menacker F. Recent trends and patterns in cesarean and vaginal birth after cesarean (VBAC) deliveries in the United States. Clin Perinatol 2011; 38 (2) 179-192
• 6 Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005; 192 (5) 1458-1461
• 7 Read JA, Cotton DB, Miller FC. Placenta accreta: changing clinical aspects and outcome. Obstet Gynecol 1980; 56 (1) 31-34
• 8 Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar AH. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol 2005; 193 (3 Pt 2) 1045-1049
• 9 Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 2013; 208 (3) 219.e1-e7
• 10 Landon MB, Hauth JC, Leveno KJ , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004; 351 (25) 2581-2589
• 11 Gyamfi-Bannerman C, Gilbert S, Landon MB , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obstet Gynecol 2012; 120 (6) 1332-1337
• 12 Grobman WA, Gersnoviez R, Landon MB , et al; National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Pregnancy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. Obstet Gynecol 2007; 110 (6) 1249-1255
• 13 Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS ONE 2012; 7 (12) e52893
• 14 Grønkjær M, Eliasen M, Skov-Ettrup LS , et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg 2013;
• 15 Cleary-Goldman J, Malone FD, Vidaver J , et al; FASTER Consortium. Impact of maternal age on obstetric outcome. Obstet Gynecol 2005; 105 (5 Pt 1) 983-990
• 16 Shipp TD, Zelop CM, Repke JT, Cohen A, Lieberman E. Interdelivery interval and risk of symptomatic uterine rupture. Obstet Gynecol 2001; 97 (2) 175-177
• 17 Conner SN, Verticchio JC, Tuuli MG, Odibo AO, Macones GA, Cahill AG. Maternal obesity and risk of postcesarean wound complications. Am J Perinatol 2013;
• 18 Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol 2010; 203 (3) 271.e1-271.e7
• 19 Rehman HU, Mohammed K. Perioperative management of diabetic patients. Curr Surg 2003; 60 (6) 607-611
• 20 Warshak CR, Ramos GA, Eskander R , et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 2010; 115 (1) 65-69
• 21 Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG 2009; 116 (5) 648-654
• 22 Eller AG, Bennett MA, Sharshiner M , et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117 (2, Pt 1) 331-337