Placenta Accreta Spectrum

Einerson, Brett D.; Gilner, Jennifer; Zuckerwise, Lisa C.

doi:10.1097/aog.0000000000005229

Cited by 18 publications

(5 citation statements)

References 113 publications

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“…Interested maternal outcomes included: (1) gestational diabetes mellitus (GDM), defined as a fasting plasma glucose ≥ 5.1 mmol/L or an OGTT 1 h plasma glucose ≥ 10.0 mmol/L, or an OGTT 2 h plasma glucose ≥ 8.5 mmol/L, that occurs or is first diagnosed during pregnancy [ 14 ]; (2) hypertensive disorders of pregnancy (HDP), defined as a spectrum of conditions including preeclampsia, preeclampsia superimposed on chronic hypertension, gestational hypertension, and chronic hypertension; (3) preeclampsia, defined as new-onset blood pressures ≥ 140/90 mmHg after 20 weeks of gestation and combined with albuminuria ≥ 0.3 g [ 15 ]; (4) placenta accreta spectrum (PAS) disorders, characterized as abnormal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall [ 16 ]; (5) placenta previa (PP), defined as placenta complete or partial covering the internal orifice of cervix; (6) cesarean delivery (CD), identified by inpatient medical records; and (7) postpartum hemorrhage (PPH), defined as a loss of ≥ 500 ml of blood after vaginal delivery or ≥ 1000 ml after CD within 24 h of birth [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Association of Paternal Age Alone and Combined with Maternal Age with Perinatal Outcomes: A Prospective Multicenter Cohort Study in China

Yin,

Zhou,

Zhao

et al. 2024

J Epidemiol Glob Health

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Maternal and paternal age at birth is increasing globally. Maternal age may affect perinatal outcomes, but the effect of paternal age and its joint effect with maternal age are not well established. This prospective, multicenter, cohort analysis used data from the University Hospital Advanced Age Pregnant Cohort Study in China from 2016 to 2021, to investigate the separate association of paternal age and joint association of paternal and maternal age with adverse perinatal outcomes. Of 16,114 singleton deliveries, mean paternal and maternal age (± SD) was 38.0 ± 5.3 years and 36.0 ± 4.1 years. In unadjusted analyses, older paternal age was associated with increased risks of gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy, preeclampsia, placenta accreta spectrum disorders, placenta previa, cesarean delivery (CD), and postpartum hemorrhage, preterm birth (PTB), large-for-gestational-age, macrosomia, and congenital anomaly, except for small-for-gestational-age. In multivariable analyses, the associations turned to null for most outcomes, and attenuated but still significant for GDM, CD, PTB, and macrosomia. As compare to paternal age of < 30 years, the risks in older paternal age groups increased by 31–45% for GDM, 17–33% for CD, 32–36% for PTB, and 28–31% for macrosomia. The predicted probabilities of GDM, placenta previa, and CD increased rapidly with paternal age up to thresholds of 36.4–40.3 years, and then plateaued or decelerated. The risks of GDM, CD, and PTB were much greater for pregnancies with younger paternal and older maternal age, despite no statistical interaction between the associations related to paternal and maternal age. Our findings support the advocation that paternal age, besides maternal age, should be considered during preconception counseling.Trial Registration NCT03220750, Registered July 18, 2017—Retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT03220750.

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Section: Methodsmentioning

confidence: 99%

Association of Paternal Age Alone and Combined with Maternal Age with Perinatal Outcomes: A Prospective Multicenter Cohort Study in China

Yin,

Zhou,

Zhao

et al. 2024

J Epidemiol Glob Health

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“…Counselling should be culturally competent, considering that those who are uninsured are more likely to be non-white patients [ 37 ]. Such care approaches and environments are important as the literature shows that post-surgical complications include high rates of posttraumatic stress disorder, pain, decreased quality of life, and poor mental health [ 38 ].…”

Section: Recommendationsmentioning

confidence: 99%

Addressing Diagnosis, Management, and Complication Challenges in Placenta Accreta Spectrum Disorder: A Descriptive Study

Abousifein,

Shishkina,

Leyland

2024

JCM

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Introduction: In light of increased cesarean section rates, the incidence of placenta accreta spectrum (PAS) disorder is increasing. Despite the establishment of clinical practice guidelines offering recommendations for early and effective PAS diagnosis and treatment, antepartum diagnosis of PAS remains a challenge. This ultimately risks poor mental health and poor physical maternal and neonatal health outcomes. Case Descriptions: This case series details the experience of two high-risk patients who remained undiagnosed for PAS until they presented with antenatal hemorrhage, leading ultimately to necessary, complex surgical interventions, which can only be optimally provide in a tertiary care center. Patient 1 is a 37-year-old woman with a history of three cesarean sections, which elevates her risk for PAS. She had placenta previa detected at 19 weeks, and placenta percreta diagnosed upon hemorrhage. During a hysterectomy, invasive placenta was found in the patient’s bladder, leading to a cystotomy and right ureteric reimplantation. After discharge, she was diagnosed with a vesicovaginal fistula, and is currently awaiting surgical repair. Patient 2 is a 34-year-old woman with two previous cesarean sections. The patient had complete placenta previa detected at 19- and 32-week gestation scans. She presented with antepartum hemorrhage at 35 weeks and 2 days. An ultrasound showed thin myometrium at the scar site with significant vascularity. A hysterectomy was performed due to placental attachment issues, with significant blood loss. Both patients were at high risk for PAS based on past medical history, risk factors, and pathognomonic imaging findings. Discussion: We highlight the importance of the implementation of clinical guidelines at non-tertiary healthcare centers. We offer clinical-guideline-informed recommendations for radiologists and antenatal care providers to promote early PAS diagnosis and, ultimately, better patient and neonatal outcomes through increased access to adequate care.

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“…Placenta accreta spectrum (PAS) is characterized by abnormal trophoblast invasion into the uterine wall, encompassing various degrees of pathological adherence, including placenta accreta, increta, and percreta. [1][2][3][4][5] The estimated incidence of PAS is 0.17% of pregnancies, 3,6 a significant increase from previous years. 3,7,8 This rise in PAS incidence can be attributed to demographic changes and notable risk factors, especially the marked increase in cesarean deliveries (CDs) in recent years.…”

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confidence: 99%

“…[1][2][3][4][5] The estimated incidence of PAS is 0.17% of pregnancies, 3,6 a significant increase from previous years. 3,7,8 This rise in PAS incidence can be attributed to demographic changes and notable risk factors, especially the marked increase in cesarean deliveries (CDs) in recent years. 3,6,[9][10][11][12][13] Other associated risk factors include placenta previa, prior occurrences of PAS, Asherman's syndrome, and various uterine procedures such as surgical terminations, in vitro fertilization (IVF), endometrial ablation, and operative hysteroscopy.…”

mentioning

confidence: 99%

“…3,7,8 This rise in PAS incidence can be attributed to demographic changes and notable risk factors, especially the marked increase in cesarean deliveries (CDs) in recent years. 3,6,[9][10][11][12][13] Other associated risk factors include placenta previa, prior occurrences of PAS, Asherman's syndrome, and various uterine procedures such as surgical terminations, in vitro fertilization (IVF), endometrial ablation, and operative hysteroscopy. 10,[14][15][16][17][18][19] PAS disorders are typically treated with cesarean hysterectomy or conservative management.…”

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confidence: 99%

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Pregnancy Outcomes after Uterine Preservation Surgery for Placenta Accreta Spectrum: A Retrospective Cohort Study

Ohayon,

Castel,

Friedrich

et al. 2024

Am J Perinatol

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Objective This study aimed to investigate maternal and neonatal outcomes in subsequent pregnancies of women with a history of placenta accreta spectrum (PAS) compared with women without history of PAS. Study Design A retrospective cohort study conducted at a single tertiary center between March 2011 and January 2022. We compared women with a history of PAS who had uterine preservation surgery and a subsequent pregnancy, to a control group matched in a 1:5 ratio. The primary outcome was the occurrence of a composite adverse outcome (CAO) including any of the following: uterine dehiscence, uterine rupture, blood transfusion, hysterectomy, neonatal intensive care unit admission, and neonatal mechanical ventilation. Multivariable logistic regression was performed to evaluate associations with the CAO. Results During the study period, 287 (1.1%) women were diagnosed with PAS and delivered after 25 weeks of gestation. Of these, 32 (11.1%) women had a subsequent pregnancy that reached viability. These 32 women were matched to 139 controls. There were no significant differences in the baseline characteristics between the study and control groups. Compared with controls, the proportion of CAO was significantly higher in women with previous PAS pregnancy (40.6 vs. 19.4%, p = 0.019). In a multivariable logistic regression analysis, previous PAS (adjusted odds ratio [aOR] = 3.31, 95% confidence interval [CI] = 1.09–10.02, p = 0.034) and earlier gestational age at delivery (aOR = 3.53, 95% CI = 2.27–5.49, p < 0.001) were independently associated with CAOs. Conclusion A history of PAS in a previous pregnancy is associated with increased risk of CAOs in subsequent pregnancies. Key Points

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Placenta Accreta Spectrum

Abstract: Updated guidance is provided for clinicians who encounter placenta accreta spectrum, a disorder for which our understanding of the cause, diagnosis, classification, and management is rapidly evolving.

Cited by 18 publications

References 113 publications

Association of Paternal Age Alone and Combined with Maternal Age with Perinatal Outcomes: A Prospective Multicenter Cohort Study in China

Association of Paternal Age Alone and Combined with Maternal Age with Perinatal Outcomes: A Prospective Multicenter Cohort Study in China

Addressing Diagnosis, Management, and Complication Challenges in Placenta Accreta Spectrum Disorder: A Descriptive Study

Pregnancy Outcomes after Uterine Preservation Surgery for Placenta Accreta Spectrum: A Retrospective Cohort Study

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