Risk factors for abnormally invasive placenta: a systematic review and meta-analysis

Iacovelli, Antonia; Liberati, Marco; Khalil, Asma; Timor-Trisch, Ilan; Leombroni, Martina; Buca, D.; Milani, Michela; Flacco, Maria Elena; Manzoli, Lamberto; Fanfani, Francesco; Calì, Giuseppe; Familiari, Alessandra; Scambia, Giovanni; D’Antonio, F.

doi:10.1080/14767058.2018.1493453

Cited by 76 publications

(59 citation statements)

References 68 publications

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“…The incidence of accreta continued to rise with increasing previous cesarean deliveries, up to 6.74% for women with previous cesarean deliveries compared with no previous CD, with an odds ratio of 29.8 (11). Compared with previous normal spontaneous vaginal delivery, previous cesarian delivery was a significant risk factor for placenta previa in many studies (14)(15)(16)(17)(18)(19)(20)(21). The highest number of previous cesarean delivery in our study was four.…”

Section: Discussionsupporting

confidence: 44%

Relationship Between the Number of Cesarean Deliveries and Maternal-fetal Complications

Turan¹,

Ozdemir²,

Atakul³

et al. 2019

meandros

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Öz Amaç: Sezeryan operasyonu tüm dünyada çok yaygın olarak ve giderek artan oranlarda yapılmaktadır. Sunulan bu çalışmada sezeryan sayısının maternal ve fetal sağlığı üzerine etkilerinin incelenmesidir. Gereç ve Yöntemler: Çalışmaya 1 Ekim 2014-1 Ekim 2017 tarihleri arasında kliniğimizde sezeryan operasyonu geçirmiş ve ek hastalığı olmayan, gebelik haftası 38-40 hafta arasında olan, gebeliği 18-40 yaşlarında olan kişiler dahil edilmiştir. Bu kişilerin doğum sonrası kayıtları retrospektif olarak incelenmiştir. Gebelik Objective: Cesarean operation is very common and it is being performed increasingly all over the world. In this study, the effect of the number of cesarean deliveries on maternal and fetal health was evaluated. Materials and Methods: We included patients who underwent cesarean section in our clinic between October 2014 and October 2017, who had no additional disease, between 38 and 40 gestational weeks, and ages between 18 and 40 years. Postnatal records were retrospectively reviewed. Patients who had pregnancy complications such as pregnancy hypertension, gestational diabetes, oligohydramnios, polyhydramnios, or who had a dysmorphic appearing baby or with any genetic syndrome were excluded. Patients were divided into three groups according to the number of cesareans they had undergone. Group 1 consisted of patients with history of two cesarean deliveries, group 2 consisted of patients with 3 cesarean deliveries and group three consisted of patients with 4 or more cesarean deliveries. Groups were then compared to each other for their demographic data and maternal-fetal outcomes. Results: Mean age of the patients studied was 32.4 years [standard deviation (SD): 4.4], mean gestational week was 38 weeks and 2 days (SD: 0.55), and mean hospitalization duration was: 4.4 days (SD: 1.0). There was no significant correlation between the number of cesarean section and the parameters of birth weight, duration of hospital stay, and appearance, pulse, grimace, activity, and respiration scores. Conclusion: The history for the number of previous cesarean deliveries for a pregnancy may not seem to be correlated with increased maternal or fetal complications up to four previous cesarean deliveries. There is a need for future studies with even larger patients to support our findings.

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Section: Discussionsupporting

confidence: 44%

Relationship Between the Number of Cesarean Deliveries and Maternal-fetal Complications

Turan¹,

Ozdemir²,

Atakul³

et al. 2019

meandros

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“…Each examiner was asked to judge the following features (Appendix S1, Figure 1): (1) presence of a PAS disorder; (2) depth of placental invasion (placenta accreta, increta or percreta); (3) topography of placental invasion in the sagittal plane (posterior upper bladder wall and uterine body, posterior lower bladder wall and lower uterine segment and cervix or no visible bladder invasion); (4) presence of parametrial invasion in the axial and coronal planes; (5) presence and number of newly formed vessels in the parametrial tissue, evaluated in the axial plane; (6) location of the placenta (anterior, posterior, lateral or fundal); (7) presence and type of placenta previa (the placenta was defined as 'placenta previa' when it was lying directly over the internal os and as 'low-lying' (16) presence of artifacts. The reference standard was the presence of a PAS disorder confirmed on histopathological assessment or, in the most severe types of invasion, on surgical evaluation.…”

Section: Methodsmentioning

confidence: 99%

“…Ultrasound is usually the primary imaging tool for assessing women at risk for a PAS disorder, such as those presenting with placenta previa and prior Cesarean delivery (CD) or uterine surgery, while magnetic resonance imaging (MRI) is performed to confirm the ultrasound diagnosis and delineate the depth and topography of placental invasion, which can significantly affect maternal outcome and influence the surgical approach [5][6][7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Interobserver agreement in MRI assessment of severity of placenta accreta spectrum disorders

Finazzo¹,

D’Antonio

Masselli

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To evaluate the level of agreement in the prenatal magnetic resonance imaging (MRI) assessment of the presence and severity of placenta accreta spectrum (PAS) disorders between examiners with expertise in the diagnosis and management of these conditions. Methods This was a secondary analysis of a prospective study including women with placenta previa or low‐lying placenta and at least one prior Cesarean delivery or uterine surgery, who underwent MRI assessment at a regional referral center for PAS disorders in Italy, between 2007 and 2017. The MRI scans were retrieved from the hospital electronic database and assessed by four examiners, who are considered to be experts in the diagnosis and surgical management of PAS disorders. The examiners were blinded to the ultrasound diagnosis, histopathological findings and clinical data of the patients. Each examiner was asked to assess 20 features on the MRI scans, including the presence, depth and topography of placental invasion. Depth of invasion was defined as the degree of adhesion and invasion of the placenta into the myometrium and uterine serosa (placenta accreta, increta or percreta) and the histopathological examination of the removed uterus was considered the reference standard. Topography of the placental invasion was defined as the site of placental invasion within the uterus in relation to the posterior bladder wall (posterior upper bladder wall and uterine body, posterior lower bladder wall and lower uterine segment and cervix or no visible bladder invasion) and the site of invasion at surgery was considered the reference standard. The degree of interrater agreement (IRA) was evaluated by calculating both the percentage of observed agreement among raters and the Fleiss kappa (κ) value. Results Forty‐six women were included in the study. The median gestational age at MRI was 33.8 (interquartile range, 33.1–34.0) weeks. A final diagnosis of placenta accreta, increta and percreta was made in 15.2%, 17.4% and 50.0% patients, respectively. There was excellent agreement between the four examiners in the assessment of the overall presence of a PAS disorder (IRA, 92.1% (95% CI, 86.8–94.0%); κ, 0.90 (95% CI, 0.89–1.00)). However, there was significant heterogeneity in IRA when assessing the different MRI signs suggestive of a PAS disorder. There was excellent agreement between the examiners in the identification of the depth of placental invasion on MRI (IRA, 98.9% (95% CI, 96.8–100.0%); κ, 0.95 (95% CI, 0.89–1.00)). However, agreement in assessing the topography of placental invasion was only moderate (IRA, 72.8% (95% CI, 72.7–72.9%); κ, 0.56 (95% CI, 0.54–0.66)). More importantly, when assessing parametrial invasion, which is one of the most significant prognostic factors in women affected by PAS, the agreement was substantial and moderate in judging the presence of invasion in the coronal (IRA, 86.6% (95% CI, 86.5–86.7%); κ, 0.69 (95% CI, 0.59–0.71)) and axial (IRA, 78.6% (95% CI, 78.5–78.7%); κ, 0.56 (95% CI, 0.33–0.60)) planes, respectively. L...

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“…The incidence of accreta continued to rise with increasing previous cesarean deliveries, up to 6.74% for women with previous cesarean deliveries compared with no previous CD, with an odds ratio (OR) of 29.8 (11). Compared with previous normal spontaneous vaginal delivery, previous cesarian delivery was a significant risk factor for placenta previa in many studies (14)(15)(16)(17)(18)(19)(20)(21). The highest number of previous cesarean delivery in our study was four.…”

Section: Discussionmentioning

confidence: 46%

Relationship Between The Number of Cesarean Deliveries and Maternal-Fetal Complications

Turan¹,

Atakul²,

Zafer³

2018

meandros

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Risk factors for abnormally invasive placenta: a systematic review and meta-analysis

Abstract: A prior CS and placenta previa are among the strongest risk factors for the occurrence of AIP.

Cited by 76 publications

References 68 publications

Relationship Between the Number of Cesarean Deliveries and Maternal-fetal Complications

Relationship Between the Number of Cesarean Deliveries and Maternal-fetal Complications

Interobserver agreement in MRI assessment of severity of placenta accreta spectrum disorders

Relationship Between The Number of Cesarean Deliveries and Maternal-Fetal Complications

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