Clinical profiles of placenta accreta spectrum: the PACCRETA population-based study.
Maternal morbidity
neonatal outcomes
placenta accreta spectrum
placenta praevia
prior caesarean
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
accepted:
29
12
2020
pubmed:
5
1
2021
medline:
1
9
2021
entrez:
4
1
2021
Statut:
ppublish
Résumé
To describe and compare the characteristics of women with placenta accreta spectrum (PAS) and their pregnancy outcomes according to the presence of placenta praevia and a prior caesarean section. Prospective population-based study. All 176 maternity hospitals of eight French regions. Two hundred and forty-nine women with PAS, from a source population of 520 114 deliveries. Women with PAS were classified into two risk-profile groups, with or without the high-risk combination of placenta praevia (or an anterior low-lying placenta) and at least one prior caesarean. These two groups were described and compared. Population-based incidence of PAS, characteristics of women, pregnancies, deliveries and pregnancy outcomes. The PAS population-based incidence was 4.8/10 000 (95% CI 4.2-5.4/10 000). After exclusion of women lost to follow up from the analysis, the group with placenta praevia and a prior caesarean included 115 (48%) women and the group without this combination included 127 (52%). In the group with both factors, PAS was more often suspected antenatally (77% versus 17%; P < 0.001) and more often percreta (38% versus 5%; P < 0.001). This group also had more hysterectomies (53% versus 21%, P < 0.001) and higher rates of blood product transfusions, maternal complications, preterm births and neonatal intensive care unit admissions. Sensitivity analysis showed similar results after exclusion of women who delivered vaginally. More than half the cases of PAS occurred in women without the combination of placenta praevia and a prior caesarean delivery, and these women had better maternal and neonatal outcomes. We cannot completely rule out that some of the women who delivered vaginally had placental retention rather than PAS; however, we found similar results among women who delivered by caesarean. Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes.
Identifiants
pubmed: 33393174
doi: 10.1111/1471-0528.16647
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1646-1655Subventions
Organisme : Ministère de l'Education Nationale, de l'Enseignement Superieur et de la Recherche
ID : AOR12156
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 John Wiley & Sons Ltd.
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