Placenta Accreta Spectrum Among Multiple Gestation: A Retrospective Analysis Based on a Chinese Population

Abstract

BackgroundIt remained controversial whether women with multiple gestation are at higher risk of placenta accreta spectrum (PAS) disorders and large-scale studies are needed. This study aimed to assess whether PAS incidence is higher among women with multiple gestation than among singleton, as well as to compare the characteristics and outcomes of PAS in multiple and singleton gestation.MethodsWomen who underwent cesarean section with live births at Peking University First Hospital from January 2015 to December 2020 were included. Demographic and clinical information was collected through chart review. Logistic regression models were used to analyze the associations between multiple gestation and PAS. The clinical characteristics and perioperative outcomes of PAS in multiple and singleton gestation were further compared.ResultsAmong the 14583 women included, 2.4% (352/14583) were diagnosed with PAS. PAS was slightly more prevalent among multiple gestations than among singletons (2.5% vs 2.4%, P=0.857). After adjusting for known risk factors and pregnancy complications, multiple gestation was associated with a higher risk of PAS (aOR=1.63, 95% CI 1.01-2.62). Among PAS patients, women who had multiple births had a significantly lower rate of previous cesarean deliveries (27.6% vs. 56.3%, P=0.003), placenta previa (17.2% vs. 56.3%, P<0.001) and invasive PAS (24.1% vs. 53.9, P=0.002) than singletons. There were no significant differences in perioperative outcomes between these two groups.ConclusionMultiple gestation could be independently associated with an elevated risk of PAS. The clinical characteristics of PAS in the multiple and singleton gestation groups differed significantly in cesarean delivery history and placenta previa. The results of this study may inform guidelines on the screening, early detection and timely intervention of PAS patients among women with multiple births.

Association of Placenta Previa With Severe Maternal Morbidity Among Patients With Placenta Accreta Spectrum Disorder

“…4 Continuous outcomes (hospital LOS and adjusted cost) were dichotomized by setting the cutoff value as a rounded number near the 75th percentile. 44 For each outcome measure, we first applied a predefined adjustment model [45][46][47] to assess the adjusted association of placenta previa with the risk of PAS outcomes. The following factors were included along with placenta previa in the predefined model: age, year, race and ethnicity, obesity status, Charlson Comorbidity Index score, PAS severity, previous cesarean delivery, multiparity, gestational weeks, the use of assisted reproductive technology, multiple gestation, hospital bed size, and hospital teaching status.…”