Placenta praevia and accreta: Analysis of a Two-Year Experience

Abstract

Objective: Our purpose was to determine the relationship between previous caesarean section and subsequent development of placenta praevia and placenta praevia with accreta. Method: A retrospective review of the case records of all women delivered with the diagnosis of placenta praevia during the 2-year period from January 1, 1995, to December 31, 1996, at the tertiary referral centre, Princess Badeea Teaching Hospital, in north Jordan. Results: There were 18,651 deliveries in the study period. 65 (0.35%) had placenta praevia, 21 (32.3%) of whom had a history of previous caesarean section. The incidence of placenta praevia was significantly increased in those with a previous caesarean section (1.87%) compared with those with an unscarred uterus (0.25%); p < 0.0001). This risk increased as the number of previous caesarean sections increased: 1.78% for one previous section; 2.4% for two, and 2.8% for three or more. The incidence of anterior placenta praevia and placenta accreta was significantly increased in those with previous caesarean scars. In the group without antecedent of caesarean section, accretism risk was 9%, with one section or more 40.8% (p < 0.005). Conclusion: There is a high association between anterior placenta praevia, placenta accreta and previous caesarean section. This was enhanced with the increasing number of previous caesarean sections. Patients with an antepartum diagnosis of placenta praevia who have had a previous caesarean section should be considered at high risk of developing placenta praevia and accreta.

First‐trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar

“…We have already referred to the high prevalence of placenta previa and accreta in women with multiple Cesarean sections1–5. In 10 of 14 cases (71%) of first‐trimester Cesarean scar pregnancies reported in the literature, the authors observed that the pregnancy penetrated deep into the myometrium (Table 1).…”

“…In women with a history of multiple Cesarean sections the incidence of placenta previa is ten times higher compared with women who had vaginal deliveries2. When the placenta is implanted over the uterine scar, it is abnormally adherent in 30–40% of cases, which often causes uncontrollable hemorrhaging at delivery2, 3. Abnormally inserted placentae are responsible for 50–65% of all obstetric hysterectomies, 66% of which have a history of previous Cesarean sections4, 5.…”

Pregnancy outcome of patients with previous four or more caesarean sections

“…The risk increased as the number of previous CSs increased (Ziadeh et al, 1999). The incidence of placenta praevia in association with 4 or more previous caesareans was five times the general obstetric population.…”

Compressive Suture of the Lower Uterine Segment for the Treatment of Postpartum Hemorrhage due to Complete Placenta Previa: A Preliminary Study

“…The reported prevalence of placenta previa [14,15,16,17] varies from 0.4 to 0.6%. The incidence is increasing mainly due to the high CS rate [18,19], as well as the rising number of assisted reproductive technique procedures [20,21].…”