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01-12-2019 | Hysterectomy | Maternal-Fetal Medicine

Hemorrhagic morbidity in placenta accreta spectrum with and without placenta previa

Authors: Bethany M. Mulla, Robert Weatherford, Allyson M. Redhunt, Anna M. Modest, Michele R. Hacker, Jonathan L. Hecht, Melissa H. Spiel, Scott A. Shainker

Published in: Archives of Gynecology and Obstetrics | Issue 6/2019

Abstract

Purpose

The incidence of placenta accreta spectrum (PAS; pathologic diagnosis of placenta accreta, increta or percreta) continues to rise in the USA. The purpose of this study is to compare the hemorrhagic morbidity associated with PAS with and without a placenta previa.

Methods

This was a retrospective cohort study of 105 deliveries from 1997 to 2017 with histologically confirmed PAS comparing outcomes in women with and without a coexisting placenta previa. We used the Wilcoxon rank sum test to compare continuous data and Chi-square or Fisher’s exact test for categorical data. We also performed log-binomial regression to calculate risk ratios adjusted for depth of invasion (aRR) and 95% confidence intervals (CI).

Results

We identified 105 pregnancies with PAS. Antenatal diagnosis of PAS was higher in women with coexisting placenta previa (72.3%) than those without (6.9%, p < 0.001). Women with coexisting placenta previa had greater median estimated blood loss and more units of packed red blood cells transfused (both p ≤ 0.03). Women with placenta previa were more likely to undergo a hysterectomy (RR 2.7; 95% CI 1.8–3.8) and be admitted to the intensive care unit (aRR 3.3; 95% CI 1.1–9.6).

Conclusions

Among women with PAS, those with a coexisting placenta previa experienced greater hemorrhagic morbidity compared to those without. In addition, PAS without placenta previa typically was not diagnosed prior to delivery. This study further supports the recommendation for multi-disciplinary planning and assurance of resources for pregnancies complicated by PAS. In addition, our results highlight the need for mobilization of resources for those pregnancies where PAS is not diagnosed until delivery.

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Title: Hemorrhagic morbidity in placenta accreta spectrum with and without placenta previa
Authors: Bethany M. Mulla
Robert Weatherford
Allyson M. Redhunt
Anna M. Modest
Michele R. Hacker
Jonathan L. Hecht
Melissa H. Spiel
Scott A. Shainker
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keyword: Hysterectomy
Published in: Archives of Gynecology and Obstetrics / Issue 6/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-019-05338-y

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Hemorrhagic morbidity in placenta accreta spectrum with and without placenta previa

Abstract

Purpose

Methods

Results

Conclusions

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Abstract

Purpose

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