Association Between Pre-delivery Coagulation Indicators and Invasive Placenta Accreta Spectrum

Abstract

Objectives To analyze the association between pre-operational coagulation indicators and the severity of placenta accreta spectrum (PAS), as well as blood loss volume during operation. Methods Hospitalized patients of the obstetric department in a major hospital from 2018 to 2020 who were clinically and/or pathologically diagnosed with invasive PAS were included. Univariate and multivariate logistic regression and Poisson regression models were used to quantify the association between each of the 6 coagulation indicators and PAS severity (measured by FIGO grade) as well as maternal outcomes. Results Ninety-five patients (46 FIGO grade 2 and 49 FIGO grade 3) were included. Higher PT [adjusted OR (aOR): 5.54; 95% CI, 1.80 to 17.07] and FDP (aOR: 1.19; 95% CI, 1.01–1.42) levels were associated with an increased risk of FIGO grade 3 after adjusting for covariates. D-dimer [incidence rate ratio (IRR): 1.19; 95% CI, 1.05 to 1.35)] and FDP (IRR: 1.03; 95% CI, 1.01–1.04) levels were significantly associated with higher blood loss volume after adjusting for covariates. Conclusion Preoperative coagulation indicators, especially PT, D-dimer and FDP, are associated with disease severity and blood loss volume during operation of invasive PAS. The underlying mechanism for the coagulation profile of PAS patients warrants further analysis. Synopsis Preoperative coagulation indicators, especially PT, D-dimer and FDP, are associated with disease severity and blood loss volume during operation among invasive placenta accreta spectrum patients.

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.…”

Maternal Smoking and the Risk of Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis

“…Several studies have shown that smoking causes hypercoagulability and increased risk of thrombosis, and during pregnancy, due to physiological adaptation, the hemostatic system presents as a relatively hypercoagulable state with decreased anticoagulation function; however, studies in women with PAS have shown that they have hypocoagulability and hyperfibrinolysis [ 36 ]; therefore, the mechanism of the association between smoking and the PAS is unknown. However, the systemic inflammation induced by air pollution affects female genital tract damage, including damage to the endometrial and myometrium epithelium, and leads to poor decidualization [ 37 , 38 ].…”

The Evolution of Management Strategies for Placenta Accreta Spectrum

“…Guo et al investigated the feasibility of routine coagulation testing prior to delivery and verified the association between prothrombin time, D-dimer, and fibrin degradation product with blood loss volume in severe PAS cases, which is the most common form of severe maternal morbidity. 22 The IS-PAS referred to these findings in their review of hemostatic considerations in PAS 23 and recommended the provision of prepartum and intrapartum coagulation testing, including complete blood count, fibrinogen levels, standard coagulation parameters, and D-dimers. In contrast, conservative management strategies may leave the placenta untouched; however, the coagulation activity induced by local trophoblasts may increase the consumption of fibrinogen and increase the levels of D-dimer, thus increasing the risk of secondary hemorrhage.…”

“…Guo et al . investigated the feasibility of routine coagulation testing prior to delivery and verified the association between prothrombin time, d -dimer, and fibrin degradation product with blood loss volume in severe PAS cases, which is the most common form of severe maternal morbidity 22 . The IS-PAS referred to these findings in their review of hemostatic considerations in PAS 23 and recommended the provision of prepartum and intrapartum coagulation testing, including complete blood count, fibrinogen levels, standard coagulation parameters, and d -dimers.…”