Interpregnancy interval and abnormally invasive placentation

Martimucci, Kristina; Bilinski, Robyn T.; Perez, Anisha M; Kuhn, Theresa; Al-Khan, Abdulla; Alvarez-Perez, Jesus

doi:10.1111/aogs.13478

Cited by 16 publications

(11 citation statements)

References 13 publications

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“…1 They performed a retrospective cohort study evaluating the role of a short interpregnancy interval (IPI) in the occurrence of abnormal invasive placentation (AIP). 1 They performed a retrospective cohort study evaluating the role of a short interpregnancy interval (IPI) in the occurrence of abnormal invasive placentation (AIP).…”

Section: Abnormally Invasive Placentation In Cohort Studies-refining mentioning

confidence: 99%

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Abnormally invasive placentation in cohort studies—Refining the methodology

Rottenstreich

2018

Acta Obstet Gynecol Scand

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Sir,We read the original research by Martimucci et al with great interest. 1 They performed a retrospective cohort study evaluating the role of a short interpregnancy interval (IPI) in the occurrence of abnormal invasive placentation (AIP). In their study, 67 women were included in the study group and 86 in the control group. The authors concluded that short IPI is not associated with increased risk of AIP.Although the authors address an important topic, several important issues warrant further clarification.As AIP has an incidence of 0.04-0.9% of cesarean deliveries (eg the wide variation in the reported incidence is mainly a result of different diagnostic criteria), properly designed studies should include a large sample size to achieve enough power to examine different hypotheses in this regard, as can be seen in previously reported retrospective cohort studies. 2 It seems that the discussed study is underpowered to deduce any conclusion regarding risk factors for AIP and the authors should be more cautious in denouncing an association between IPI and AIP. Secondly, it might have been more methodologically appropriate if several study groups with different IPIs were investigated, examining the incidence of AIP in each of these groups.Thirdly, the authors chose to stratify the IPI sample by 18month intervals, in light of a seminal study by Bujold et al 3 which in fact used an arbitrary IPI division. Coupled with the notion that uterine rupture is more probably associated with myometrial healing and strength than with endometrial healing (which could be more important for the pathophysiology of AIP development), we find an IPI of 18 months to be inappropriate for the authors' study question. As it has been shown that satisfactory healing of the uterine wall is likely to occur within 12 months following cesarean section (and that additional healing would be limited following this time period) 4 and that a second pregnancy within 12 months after a cesarean delivery was associated with increased risks of placenta previa, 5 it would be interesting to examine an IPI interval of 12 months instead. Finally, the authors recommend that other risk factors could be evaluated in future studies such as cesarean delivery performed electively (prelabor) or during labor (intrapartum). It is worth noting that such studies have been performed in the last decade, which concluded that primary cesarean delivery is associated with increased risk for AIP when compared with intrapartum cesarean delivery. O RCI D JR. Interpregnancy interval and abnormally invasive placentation. Acta Obstet Gynecol Scand. 2019;98:183-187. 2. 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(219):e1-e7. 3. Bujold E, Gauthier RJ. Risk of uterine rupture associated with an interdelivery interval between 18 and 24 months. Obstet Gynecol. 2010;115:1003-1006. 4. Sumigama S, Sugiyama C, Kotani T, et al. Uterine sutures at prior caesarean sect...

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Section: Abnormally Invasive Placentation In Cohort Studies-refining mentioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

Abnormally invasive placentation in cohort studies—Refining the methodology

Rottenstreich

2018

Acta Obstet Gynecol Scand

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“…We estimated that a sample size (with continuity correction) of 214 with a 1 : 1 case to control ratio (107 cases and 107 controls) would allow us to accept a two-tailed alpha error of 0.05 and beta error (type II error) of 0.10 at 90% power using the prevalence of placenta previa of 26.7% [ 15 ] for women with short IPI following previous cesarean section and an expected decrease of 10.0% in the controls with normal IPI. However, we recruited 139 participants in each of the case and control groups to account for possible loss to follow-up.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Placenta Previa and Placenta Accreta Spectrum Disorder Following Previous Cesarean Section between Women with a Short and Normal Interpregnancy Interval

Umeh

Eleje

Onuh

et al. 2022

Obstetrics and Gynecology International

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Objectives. The aim of this study is to determine the effect of interpregnancy interval (IPI) on the incidence of placenta previa and placenta accreta spectrum disorders in women with a previous cesarean section. Methods. A prospective cohort three-center study involving parturients who had previous cesarean section was conducted. Participants were included if pregnancy has lasted up to 34 weeks. Parturients with co-existing uterine fibroids, multiple gestations, premature rupture of membranes, and those with prior postcesarean delivery wound infection were excluded. The eligible women recruited were distributed into two groups, namely, short (<18 months) and normal (18–36 months) IPI. The outcome measures were incidences of placenta previa and placenta accreta spectrum disorder and factors associated with the occurrence of placenta previa. A univariate analysis was performed using the chi-square test or Mann–Whitney U test, wherever appropriate, to examine the significance of the differences in clinical variables. Results. A total of 248 women met the inclusion criteria. The incidence of placenta previa by ultrasound was 8.9% and 4.0% for short and normal IPI (odds ratios = 2.32; 95% confidence intervals = 0.78–6.88; p = 0.13 ), respectively. The incidence of placenta accreta spectrum disorder was 1.6% and 0.8% for short and normal IPI (odds ratios = 2.02; 95% confidence intervals = 0.18–22.13; p = 0.57 ), respectively. The only observed significant difference between the clinical variables and placenta previa is the number of cesarean sections ( p = 0.02 ) in women with short IPI. Conclusion. A short interpregnancy interval does not significantly affect the incidence of placenta previa and placenta accreta spectrum disorder following a cesarean section. There is a need for further study with large numbers to corroborate these findings in low- and middle-income settings.

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“…1 In the letter by Levin & Rottenstreich 2 the authors wrote that a well-designed study should include a large sample size to achieve a high enough power, referencing Eshkoli et al 3 That paper had 139 women as the study group with clinically diagnosed placenta accreta, and 34 000 women which included all the cesarean deliveries during that time period that were not associated with placenta accreta. 1 In the letter by Levin & Rottenstreich 2 the authors wrote that a well-designed study should include a large sample size to achieve a high enough power, referencing Eshkoli et al 3 That paper had 139 women as the study group with clinically diagnosed placenta accreta, and 34 000 women which included all the cesarean deliveries during that time period that were not associated with placenta accreta.…”

Section: Sirmentioning

confidence: 99%

“…Thank you for your comments on our manuscript. 1 In the letter by Levin & Rottenstreich 2 the authors wrote that a well-designed study should include a large sample size to achieve a high enough power, referencing Eshkoli et al 3 That paper had 139 women as the study group with clinically diagnosed placenta accreta, and 34 000 women which included all the cesarean deliveries during that time period that were not associated with placenta accreta. Eshkoli et al's paper sought to evaluate risk factors for placenta accreta and found that placenta previa is an independent risk factor.…”

Section: Sirmentioning

confidence: 99%