Incidence and Risk Factors for Placenta Accreta/Increta/Percreta in the UK: A National Case-Control Study

Fitzpatrick, Kathryn; Sellers, Susan; Spark, P; Kurinczuk, Jennifer J; Brocklehurst, Peter; Knight, Marian

doi:10.1371/journal.pone.0052893

Cited by 348 publications

(319 citation statements)

References 18 publications

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“…Cases included in the analysis of socioeconomic inequalities were women who suffered from one of the following six conditions of severe maternal morbidity directly attributable to pregnancy causes: AFE, 32 AFLP, 30 eclampsia, 28 peripartum hysterectomy, 31 peripartum haemorrhage 129 and uterine rupture. 181 For the ethnic inequality study, in addition to these six conditions, cases were included from a further five conditions: antenatal pulmonary embolism, 29 stroke in pregnancy, 74 placenta accreta, 72 HELLP syndrome 54 and severe sepsis. 99 These data sets represented the entirety of data available on direct maternal morbidities and control women at the time the analyses were conducted.…”

Section: Secondary Data Analysismentioning

confidence: 99%

“…This represents only a summary of key points; many more specific messages for care are reported in the publications about individual conditions and these should be referred to for further detail. 54,71,72,181,220,221 The incidence of the specific morbidities most commonly leading to maternal death in the UK We examined the incidence of AFE, severe maternal sepsis, uterine rupture, HELLP syndrome and placenta accreta/increta/percreta. Because the studies conducted were national cohort or case-control studies, we were able to estimate incidence of each condition with a relatively high degree of precision.…”

Section: Key Findings and Implications For Practice Or Policymentioning

confidence: 99%

“…72 It is thus clear that, in particular, the women who have had one or more previous caesarean deliveries and have a placenta praevia must be delivered in a unit that is equipped for the possibility of a placenta accreta/increta/percreta and associated haemorrhage, with appropriate delivery planning and the availability of a team to carry out a peripartum hysterectomy should this be necessary.…”

Section: Key Findings and Implications For Practice Or Policymentioning

confidence: 99%

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Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Secondary Data Analysismentioning

confidence: 99%

Section: Key Findings and Implications For Practice Or Policymentioning

confidence: 99%

Section: Key Findings and Implications For Practice Or Policymentioning

confidence: 99%

See 1 more Smart Citation

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

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“…It happens in 1/10000 delivery according to international literature [2,3]. APA is significantly associated with severe obstetric complications involving the vital prognosis of patients (severe bleeding, multiple transfusions, per partum hysterectomy and death....).…”

Section: Introductionmentioning

confidence: 99%

“…The steady increase of caesarean sections [4], maternal age, IVF [3], voluntary abortions by curettage and are all known risk factors that may increase the incidence of APA [5,6].…”

Section: Introductionmentioning

confidence: 99%

New Multidisciplinary Approach of Conservative Surgical Management of Placenta Percreta Antenatally Diagnosed

A¹

2014

Surgery Curr Res

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Background: Placenta percreta, accreta, increta and transcreta are abnormal placentation adherence (APA), significantly associated with high maternal morbidity and mortality. When APA is suspected antenatally there are two current recommended alternatives: a radical treatment by planned cesarean-hysterectomy or a conservative management leaving the placenta in place with secondary uterine devascularization by embolisation, in aim to preserve fertility but at the cost of heavy monitoring and possibly severe complications and secondary hysterectomy. A third option could be considered when APA is antenatally diagnosed. This is a multidisciplinary planned management, consisting in per operative placental localization and delivery of the fetus via transverse uterine incision above the upper edge of the placenta. Then pelvic devascularization by inflation of internal iliac artery balloons preoperatively inserted is established and excision of the accreta part of the placenta followed by reconstruction of the uterine wall defect with healthy myometrium is performed.

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The Placenta as a Critical Care Issue

Fox

Rac

Shamshirsaz

et al. 2018

Critical Care Obstetrics

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Incidence and Risk Factors for Placenta Accreta/Increta/Percreta in the UK: A National Case-Control Study

Cited by 348 publications

References 18 publications

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

New Multidisciplinary Approach of Conservative Surgical Management of Placenta Percreta Antenatally Diagnosed

The Placenta as a Critical Care Issue

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