Maternal and neonatal outcomes of placenta increta and percreta from a multicenter study in China

Zhang, Huijing; Dou, Ruochong; Yang, Huixia; Zhao, Xin; Chen, Dunjin; Ding, Ye; Ding, Hongjuan; Cui, Shihong; Zhang, Weishe; Xin, Hong; Gu, Weirong; Hu, Yali; Ding, Guifeng; Qi, Hongbo; Liu, Fan; Ma, Yuyan; Lu, Junli; Yang, Yongmei; Luo, Xian; Zhang, Xiaohong; Fan, Shang­rong

doi:10.1080/14767058.2018.1442429

Cited by 25 publications

(23 citation statements)

References 13 publications

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“…The hysterectomy rate of penetrating placenta accreta was 50%, which was higher than the hysterectomy rate of placenta increta and placental accreta, which were 15.8%% and 0% respectively. Some scholars revealed that the depth of placenta implantation was associated with the severity of outcomes; A large-scale retrospective analysis in China found that the hysterectomy rate for penetrating placenta accreta was 43.3%, and the hysterectomy rate for placental accreta was 11.2%, which were statistically signi cant and similar to our research [23]. Another study also showed the rate of hysterectomy during cesareans and the total hysterectomy rate were signi cantly higher in the percreta than the accreta group (52.9% vs 20.9%, 84.3%vs 23.8%).…”

Section: Discussionsupporting

confidence: 88%

Analysis of Related Influencing Factors of Hysterectomy in Patients With Placenta Accreta Spectrum Disorders After Uterine Artery Embolization

Zheng

Shen

Liu

et al. 2020

Preprint

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Objective: To estimate the related factors of hysterectomy in patients with Placenta accreta spectrum (PAS) after uterine artery embolization (UAE), and try to evaluate the effectiveness and safety of UAE in patients with PAS.Methods: From January 2012 to July 2020, a retrospective analysis was performed in 85 patients undergoing TAE for PAS. Information regarding clinical data, angiography as well as embolization details, and clinical outcomes was obtained. Univariate and multivariate analyses were performed to determine the factors related to hysterectomy.Results: Bleeding greater than or equal to 500ml during the delivery(p = 0.037), the placenta type by MR or US(placenta increta vs placenta percreta, P = 0.01) and the type of ovarian artery(No vs Bilateral, P = 0.005; Unilateral vs Bilateral, P = 0.01) were independent risk factors of hysterectomy in PAS patients treated with UAE. The area under the curve (AUC) of the predictive model that incorporated the independent risk factors was 0.844. Abnormal collateral vessels communicating with uterine artery were observed on angiography in 24 patients (28.2%) with 31 abnormal collateral vessels. The major abnormal collateral vessel was the abnormal branches of the internal iliac artery(n = 13), followed by the inferior vesical artery (n = 11), internal pudendal artery(n = 3), obturator artery (n = 2), vaginal artery(n = 1) and the abnormal branches of the external iliac artery(n = 1).Conclusions: TAE is safe and effective for patients with PAS. Bleeding greater than or equal to 500ml during the delivery, the placenta type by MR or US and the type of ovarian artery were related to the hysterectomy. For patients with hypertrophic ovarian-uterine artery anastomosis and no fertility requirements, Ovarian artery embolization(OAE) could be a feasible choice.

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Section: Discussionsupporting

confidence: 88%

Analysis of Related Influencing Factors of Hysterectomy in Patients With Placenta Accreta Spectrum Disorders After Uterine Artery Embolization

Zheng

Shen

Liu

et al. 2020

Preprint

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“…The present results revealed that risk factors for PA were pre-pregnancy weight, gravida, number of miscarriages, number of CS, history of PROM, previous transverse incisions with cesarean section, a history of PP, and with prenatal hemorrhage or placenta previa. These results are consistent with previous studies [7][8][9][10][11][12][13][14].…”

Section: Risk Factors For Placenta Accretasupporting

confidence: 94%

“…Placenta accreta is one of the most common complications in obstetrics, and it was reported that [11] its incidence had increased annually from 1.593% in 2011 to 6.176% in 2015. In addition, a previous study showed that the prevalence of PA between 1982 and 2018 ranged from 0.01 to 1.1% [19].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Pregnancy Outcome in Women With a History of Cesarean Section Complicated by Placenta Accreta

Liang

Zhang

et al. 2020

Preprint

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Objective: To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta.Methods: This retrospective study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in 7 provinces of China between January 2017 and December 2017. According to the intraoperative findings or the pathologic diagnosis after delivery, the study population was divided into placenta accreta (PA) and non-PA groups. We compared the pregnancy outcomes between the 2 groups, used multivariate logistic regression to analyze the risk factors for placental accreta, and used receiver operating characteristic curves to evaluate the value of the risk factors.Results: For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage, severe postpartum hemorrhage, diffuse intravascular coagulation, puerperal infection, intraoperative bladder injury, hysterectomy, and blood transfusion was significantly increased in the placenta accreta group (P<0.05)). At the same time, the rate of neonatal low-birth weight, the probability of neonatal comorbidities, and the rate of neonatal intensive care unit admission also increased significantly (P<0.05). Weight, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membrane, previous cesarean-section transverse incisions, history of placenta previa, and the combination of prenatal hemorrhage and placenta previa were all independent risk factors for placenta accreta; while non-Han ethnicity was an independent protective factor for placenta accreta (P<0.05). The area under the ROC curve (AUC) was 0.93 (95% CI=0.92-0.94); and the specificity, sensitivity, and accuracy rate were 0.87, 0.93, and 0.93, respectively.Conclusions: There was an increased risk of adverse outcomes in pregnancies complicated by placenta accreta in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, Han ethnicity, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with placenta accreta in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placental accreta in pregnancies of women with a history of cesarean section.

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“…Furthermore, most case series include only one or two placenta percreta series—the condition associated with the highest risk of maternal and fetal morbidity and mortality. In clinical practice, the exact MAP classification criteria still vary from study to study, especially in terms of placenta accrete [ 3 ]. Although histological examination is recommended, it may not be accurate when the uterus is conserved.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of a previous history of cesarean section is associated with a high risk of MAP. The increasing MAP prevalence and severity of the related adverse outcomes have attracted high levels of attention, especially in cases with placenta increta and percreta [ 3 ]. In this study, we sought to focus on placenta increta and percreta.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Prophylactic Balloon-Assisted Occlusion of the Internal Iliac Arteries in the Management of Placenta Increta/Percreta

et al. 2020

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Background and Objectives: Preoperative prophylactic balloon-assisted occlusion (PBAO) of the internal iliac arteries minimizes blood loss and facilitates surgery performance, through reductions in the rate of uterine perfusion, which allow for better control in hysterectomy performance, with decreased rates of bleeding and surgical complications. We aimed to investigate the maternal and fetal outcomes associated with PBAO use in women with placenta increta or percreta. Material and Methods: The records of 42 consecutive patients with a diagnosis of placenta increta or percreta were retrospectively reviewed. Of 42 patients, 17 patients (40.5%) with placenta increta or percreta underwent cesarean delivery after prophylactic balloon catheter placement in the bilateral internal iliac artery (balloon group). The blood loss volume, transfusion volume, postoperative hemoglobin changes, rates of hysterectomy and hospitalization, and infant Apgar score in this group were compared to those of 25 similar women who underwent cesarean delivery without balloon placement (surgical group). Results: The mean intraoperative blood loss volume in the balloon group (2319 ± 1191 mL, range 1000–4500 mL) was significantly lower than that in the surgical group (4435 ± 1376 mL, range 1500–10,500 mL) (p = 0.037). The mean blood unit volume transfused in the balloon group (2060 ± 1154 mL, range 1200–8000 mL) was significantly lower than that in the surgical group (3840 ± 1464 mL, range 1800–15,200 mL) (p = 0.043). There was no significant difference in the postoperative hemoglobin change, hysterectomy rates, length of hospitalization, or infant Apgar score between the groups. Conclusion: PBAO of the internal iliac artery prior to cesarean delivery in patients with placenta increta or percreta is a safe and minimally invasive technique that reduces the rate of intraoperative blood loss and transfusion requirements.

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Maternal and neonatal outcomes of placenta increta and percreta from a multicenter study in China

Abstract: The incidence of placenta increta and placenta percreta is likely to increase in China. The depth of placenta implantation is associated with the severity of outcomes. Placenta percreta tends to have worse maternal and neonatal outcomes.

Cited by 25 publications

References 13 publications

Analysis of Related Influencing Factors of Hysterectomy in Patients With Placenta Accreta Spectrum Disorders After Uterine Artery Embolization

Analysis of Related Influencing Factors of Hysterectomy in Patients With Placenta Accreta Spectrum Disorders After Uterine Artery Embolization

Risk Factors and Pregnancy Outcome in Women With a History of Cesarean Section Complicated by Placenta Accreta

Preoperative Prophylactic Balloon-Assisted Occlusion of the Internal Iliac Arteries in the Management of Placenta Increta/Percreta

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