Gynecologic and obstetric investigation · 2025
The Number of Previous Cesarean Deliveries and Severity of Placenta Accreta Spectrum: A Referral Center Experience.
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Agarwal Neha, Hernandez-Andrade Edgar A, Gerulewicz Donatella, Papanna Ramesha, Lai Dejian, Soto Torres Eleazar E, Mehl Sarah T, Kassir Elias, Amro Farah H, Sibai Baha M, Blackwell Sean C
Аннотация
OBJECTIVE: The objective of this study was to evaluate the frequency of severe stages of placenta accreta spectrum (PAS) in relation to the number of previous cesarean deliveries (PCDs).
DESIGN: We conducted a retrospective cohort study.
SETTING: The study was carried out at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
PARTICIPANTS: A total of 176 patients with histopathologically confirmed PAS were included in the study. The frequency of each stage of PAS severity was analyzed in relation to the number of PCDs Methods: Differences in the frequency of different stages of PAS severity among patients with varying numbers of PCDs were estimated. Adjusted logistic regression models were used to evaluate the association between the number of PCDs and PAS severity.
RESULTS: In our referral center, the frequency of placenta accreta was 18.1% (n = 32/176), placenta increta 55.6% (n = 98/176), and placenta percreta 26.1% (n = 46/176). There were 8 patients with no PCDs, 48 with 1 PCD, 62 with 2 PCDs, and 58 with ≥3 PCDs. The frequency of placenta increta was similar among all PCDs groups; however, the frequency of placenta percreta was significantly higher among women with ≥3 PCDs (25/58 [43.1%]) as compared to those with ≤2 PCDs (21/118 [17.7%], aOR, 3.49 [95% confidence interval, 1.73-7.05]; p = 0.005). Patients with no PCDs had a higher frequency of placenta accreta and a similar frequency of placenta increta to those with a history of PCDs.
LIMITATIONS: The study was conducted at a single center with a high referral rate for severe forms of PAS, which may restrict the generalizability of the findings. Additionally, the classification of PAS relies heavily on histopathologic interpretation, which can introduce potential biases depending on provider experience and the criteria used.
CONCLUSION: The frequency placenta increta was similar among women with the suspicion of PAS regardless of the number of PCDs. Women with ≥3 PCDs had a significantly higher frequency of placenta percreta.
DESIGN: We conducted a retrospective cohort study.
SETTING: The study was carried out at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
PARTICIPANTS: A total of 176 patients with histopathologically confirmed PAS were included in the study. The frequency of each stage of PAS severity was analyzed in relation to the number of PCDs Methods: Differences in the frequency of different stages of PAS severity among patients with varying numbers of PCDs were estimated. Adjusted logistic regression models were used to evaluate the association between the number of PCDs and PAS severity.
RESULTS: In our referral center, the frequency of placenta accreta was 18.1% (n = 32/176), placenta increta 55.6% (n = 98/176), and placenta percreta 26.1% (n = 46/176). There were 8 patients with no PCDs, 48 with 1 PCD, 62 with 2 PCDs, and 58 with ≥3 PCDs. The frequency of placenta increta was similar among all PCDs groups; however, the frequency of placenta percreta was significantly higher among women with ≥3 PCDs (25/58 [43.1%]) as compared to those with ≤2 PCDs (21/118 [17.7%], aOR, 3.49 [95% confidence interval, 1.73-7.05]; p = 0.005). Patients with no PCDs had a higher frequency of placenta accreta and a similar frequency of placenta increta to those with a history of PCDs.
LIMITATIONS: The study was conducted at a single center with a high referral rate for severe forms of PAS, which may restrict the generalizability of the findings. Additionally, the classification of PAS relies heavily on histopathologic interpretation, which can introduce potential biases depending on provider experience and the criteria used.
CONCLUSION: The frequency placenta increta was similar among women with the suspicion of PAS regardless of the number of PCDs. Women with ≥3 PCDs had a significantly higher frequency of placenta percreta.