Contribution of Placenta Accreta to the Incidence of Postpartum Hemorrhage and Severe Postpartum Hemorrhage

Mehrabadi, Azar; Hutcheon, Jennifer A.; Liu, S.; Bartholomew, Sharon; Kramer, Mark S.; Liston, Robert; Joseph, K.S.

doi:10.1097/01.aoa.0000479493.59129.32

Cited by 26 publications

(32 citation statements)

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“…Mothers with AIP were found to have an 18‐fold greater risk of maternal morbidity, after adjusting for other pregnancy characteristics. Higher risk of hemorrhage, blood transfusion, readmission and ICU admission were found, consistent with previous studies . Hysterectomy was recorded for 12% of women with AIP, lower than reported elsewhere ; however, there is known under‐reporting of hysterectomy in these datasets and the true hysterectomy rate is likely to be higher .…”

Section: Discussionsupporting

confidence: 88%

Maternal and neonatal outcomes following abnormally invasive placenta: a population‐based record linkage study

Baldwin

Patterson

Nippita

et al. 2017

Acta Obstet Gynecol Scand

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Introduction. Abnormally invasive placenta involves abnormal adherence of the placenta to the myometrium and is associated with severe pregnancy complications such as blood transfusion and hysterectomy. Knowledge of outcomes has been limited by small sample sizes and a focus on maternal rather than neonatal outcomes. This study uses population-level data collected over 10 years to investigate maternal and neonatal outcomes and trends in incidence of abnormally invasive placenta (also known as placenta accreta, increta and percreta). Material and methods. A population-based record linkage study was performed, including all women who gave birth in New South Wales, Australia, between 2003 and 2012. Data were obtained from birth records, hospital admissions and deaths registrations. Modified Poisson regression models, adjusted for confounding factors, were used to quantify the effect of abnormally invasive placenta on adverse maternal and neonatal outcomes. Results. Abnormally invasive placenta was significantly associated with morbidity for mothers (adjusted relative risk 17.6, 99% confidence interval 14.5-21.2) and infants (adjusted relative risk 3.1, 99% confidence interval 2.7-3.5). Abnormally invasive placenta increased risk of stillbirth (relative risk 5.4, 99% confidence interval 4.0-7.3) and neonatal death (relative risk 8.0, 99% confidence interval 1.5-41.6). The overall rate of abnormally invasive placenta was 24.8 per 10 000 deliveries, and 22.7 per 10 000 among primiparae. Incidence increased by 30%, from 20.6 to 26.9 per 10 000, over the 10-year study period. Conclusions. Abnormally invasive placenta substantially increases the risk of severe adverse outcomes for mothers and babies, and the incidence is increasing. Delivery should occur in tertiary hospitals equipped with neonatal intensive care units. Clinicians should be cognizant of the risks, particularly to infants, and maintain a high index of suspicion of abnormally invasive placenta, including in primiparae.

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Section: Discussionsupporting

confidence: 88%

Maternal and neonatal outcomes following abnormally invasive placenta: a population‐based record linkage study

Baldwin

Patterson

Nippita

et al. 2017

Acta Obstet Gynecol Scand

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“…Several previous studies have explored peripartum hemorrhage in such cases. However, most studies have focused on adherent placenta . Because adherent placenta is not always associated with post‐partum hemorrhage, the use of only such patients when seeking to construct a model predicting massive post‐partum bleeding in cases of placenta previa is a limitation.…”

Section: Discussionmentioning

confidence: 99%

Scoring model to predict massive post‐partum bleeding in pregnancies with placenta previa: A retrospective cohort study

Lee

Ahn

Kang

et al. 2017

J of Obstet and Gynaecol

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Aim: We aimed to identify factors associated with massive post-partum bleeding in pregnancies with placenta previa and to establish a scoring model to predict post-partum severe bleeding. Methods: A retrospective cohort study was performed in 506 healthy singleton pregnancies with placenta previa from 2006 to 2016. Cases with intraoperative blood loss (≥2000 mL), packed red blood cells transfusion (≥4), uterine artery embolization, or hysterectomy were defined as massive bleeding. After performing multivariable analysis, using the adjusted odds ratios (aOR), we formulated a scoring model. Results: Seventy-three women experienced massive post-partum bleeding (14.4%). After multivariable analysis, seven variables were associated with massive bleeding: maternal old age (≥35 years; aOR 1.79, 95% confidence interval [CI] 1.00-3.20, P = 0.049), antepartum bleeding (aOR 4.76, 95%CI 2.01-11.02, P < 0.001), non-cephalic presentation (aOR 3.41, 95%CI 1.40-8.30, P = 0.007), complete placenta previa (aOR 1.93, 95% CI 1.05-3.54, P = 0.034), anterior placenta (aOR 2.74, 95%CI 1.54-4.89, P = 0.001), multiple lacunae (≥4; aOR 2.77, 95%CI 1.54-4.99, P = 0.001), and uteroplacental hypervascularity (aOR 4.51, 95%CI 2.30-8.83, P < 0.001). We formulated a scoring model including maternal old age (<35: 0, ≥35: 1), antepartum bleeding (no: 0, yes: 2), fetal non-cephalic presentation (no: 0, yes: 2), placenta previa type (incomplete: 0, complete: 1), placenta location (posterior: 0, anterior: 1), uteroplacental hypervascularity (no: 0, yes: 2), and multiple lacunae (no: 0, yes: 1) to predict post-partum massive bleeding. According to our scoring model, a score of 5/10 had a sensitivity of 81% and a specificity of 77% for predicting massive post-partum bleeding. The area under the receiver-operator curve was 0.856 (P < 0.001). The negative predictive value was 95.9%. Conclusion: Our scoring model might provide useful information for prediction of massive post-partum bleeding in pregnancies with placenta previa.

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“…The presence of this disease may lead to massive obstetric hemorrhage with severe maternal and fetal complications, such as emergency hysterectomy, massive blood transfusion, cystotomy, prolonged hospitalization, and even maternal and/or fetal death …”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta‐analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta

Mucio¹,

Serruya²,

Alemán

et al. 2019

Intl J Gynecology & Obste

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Background The incidence of placenta accreta has increased in recent years and it has been suggested that the rising trend in cesarean delivery and other uterine surgery is the underlying cause. Objective To explore the magnitude of the effect of performing single and repeat cesarean deliveries or other uterine surgery on the incidence of placenta accreta. Search strategy Relevant databases were searched for papers published before August 1, 2018, using terms including “accreta” and “cesarean.” Selection criteria Cohort studies assessing the risk of placenta accreta according to women's history of uterine surgery. Data collection and analysis Meta‐analyses were performed to assess the risks associated between uterine surgery and placenta accreta, hysterectomy, and uterine rupture. The I2 statistic was used to examine between‐study heterogeneity. Main results The risk of placenta accreta in a second pregnancy increased for women who had undergone a cesarean in their first pregnancy compared with vaginal delivery (OR 3.02; 95% CI, 1.50–6.08). Absolute risk of placenta accreta increased with the number of previous cesareans. The risk of uterine rupture and hysterectomy was also associated with the number of cesareans. Conclusions Risk of placenta accreta, hysterectomy, and uterine rupture increases with the number of previous cesarean deliveries. PROSPERO: CRD42016050646.

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Contribution of Placenta Accreta to the Incidence of Postpartum Hemorrhage and Severe Postpartum Hemorrhage

Cited by 26 publications

References 0 publications

Maternal and neonatal outcomes following abnormally invasive placenta: a population‐based record linkage study

Maternal and neonatal outcomes following abnormally invasive placenta: a population‐based record linkage study

Scoring model to predict massive post‐partum bleeding in pregnancies with placenta previa: A retrospective cohort study

A systematic review and meta‐analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta

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