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

Abstract

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.

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

“…Currently, patients with PAS disorder cause major concern to obstetricians, particularly since the incidence of abnormal placentation has increased significantly even among primiparous women, with reported rates ranging from 1/2510 to 1/533 births . Risks associated with any type of PAS include uncontrollable obstetric hemorrhage, emergency hysterectomy and, in very aggressive forms, urinary tract injury .…”

Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis

“…19, [47][48][49][50][51][52] Twenty-eight (28/29) were published after the year 2000 (Table 1). There were 18 studies from a single institution 14,[26][27][28][29][30][31]33,[36][37][38][39][40]42,44 , three involving two affiliated institutions 32,34,51 , two studies from the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network 48,50 , two regional studies 43,46 , three national studies 41,45,49 and two international studies involving four 19 and two 52 countries, respectively.…”

“…The clinical criteria described by the authors for the clinical diagnosis of placenta accreta spectrum at delivery felt into three categories (Table 2): basic description 32,34,35,[38][39][40]44,47,48,50,51 ; extended description 27,30,33 ; and World Health Organization (WHO) international classification. 19,36,43,46 More than a third of the studies (11/29) 14,26,29,31,37,41,42,45,49,52 did not describe the clinical criteria used for the diagnosis of placenta accreta spectrum at birth. Lateral extension of the accreta areas and detailed description of the uterine vasculature anatomical changes associated with invasive placentation were not reported by any of the 29 studies.…”

“…absence of decidua between the placental villi and uterine myometrium, to confirm the clinical diagnosis (Table 2). Three studies 34,35,38 reported on the invasion of the myometrium by placental villous tissue and four studies 20, 45,46,50 reported having confirmed the clinical diagnosis by pathologic examination at birth but with no description or reference to the criteria used. Detailed histopathologic data on the depth of villous invasiveness were only reported by ten studies 14,29,30,31,[36][37][38]42,49,52 and included 473/757 (62.5%) cases of placenta creta, 117/757 (15.4%) placenta increta and 167/757 (22.1%) placenta percreta (Table 3).…”

Patient’s blood management in obstetric practice with placenta accrete

“…В последние десятилетия отмечен значительный рост частоты нарушений плацентации, что, очевидно, связано со значимым увеличением родоразрешения путем операции кесарева сечения. Непосредственный вклад врастания плаценты в долю материнской смертности составляет 7% [2]. Известно, что врастание плаценты является наиболее распространенной причиной гистерэктомии при абдоминальном родоразрешении в развитых странах, достигая 47% [3].…”