Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2023 | Sectio Caesarea | Research

Risk factors for postpartum haemorrhage in women with histologically verified placenta accreta spectrum disorders: a retrospective single-centre cross-sectional study

Authors: Naghmeh Ghaem Maghami, Fabrice Helfenstein, Gwendolin Manegold-Brauer, Gabriela Amstad

Published in: BMC Pregnancy and Childbirth | Issue 1/2023

Abstract

Background

Placenta accreta spectrum (PAS) disorders have been reported with an increasing frequency of up to 3%. The increase in the incidence can be explained by the rising rate of Caesarean section (CS), assisted reproductive technology (ART) and previous uterine surgeries. PAS disorders are usually associated with postpartum haemorrhage (PPH). In our study, we investigated the risk factors for increased blood loss in women with histologically verified PAS disorders independent of delivery mode.

Methods

In a retrospective single-centre cross-sectional study, 2,223 pregnant women with histologically verified PAS disorders were included. Risk factors for PPH in women with PAS disorders were examined and compared between women with PPH (study group; n = 879) and women with normal blood loss (control group; n = 1150), independent of delivery mode. PAS disorders were diagnosed histologically from the following specimens: placenta, placental-bed specimens, uterine curettage, uterine resection and/or total/partial hysterectomy. Medical data were extracted from clinical records of pregnant women with PAS disorders delivering at the University Hospital Basel between 1986 and 2019. The placenta data of women with PAS disorders were obtained and identified through a search from the database of the Department of Pathology, University Hospital Basel.

Results

Between 1986 and 2019, there were 64,472 deliveries at the University Hospital Basel. PAS disorders were histologically verified in 2,223 women (2,223/64,472), and the prevalence of PAS disorders was 3.45%. A total of 879 women with PAS disorders showed PPH, independent of delivery mode (43.3%). Due to missing data for 194 women, the final analysis was conducted with the remaining 2,029 women. Placenta praevia (O.R. = 6.087; 95% CI, 3.813 to 9.778), previous endometritis (O.R. = 3.011; 95% CI, 1.060 to 9.018), previous manual placenta removal (O.R. = 2.530; 95% CI, 1.700 to 3.796), ART (O.R. = 2.169; 95% CI, 1.593 to 2.960) and vaginal operative birth (O.R. = 1.715; 95% CI, 1.225–2.428) can be considered important risk factors, and previous CS (O.R. = 1.408; 95% CI, 1.016 to 1.950) can be considered a moderate potential risk factor of PPH in women with PAS disorders.

Conclusions

Placenta praevia, previous endometritis, previous placenta removal, ART and vaginal operative birth can be considered important risk factors of PPH in women with PAS disorders.

Study registration

The study was registered under http://www.ClinicalTrials.gov (NCT05542043) on 15 September 2022.

Available only for authorised users

Jauniaux E, Ayres-de-Campos D. FIGO consensus guidelines on placenta accreta spectrum disorders: introduction. Int J Gynaecol Obstet. 2018;140(3):261–4.PubMedCrossRef

Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259–e75.CrossRef

Ali H, Chandraharan E. Etiopathogenesis and risk factors for placental accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol. 2021;72:4–12.PubMedCrossRef

Aalipour S, Salmanian B, Fox KA, Clark SL, Shamshirsaz AA, Asl NM et al. Placenta Accreta Spectrum: correlation between FIGO Clinical classification and histopathologic findings. Am J Perinatol. 2021.

Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadóttir RI, et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the nordic countries. BJOG. 2016;123(8):1348–55.PubMedCrossRef

Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int J Gynaecol Obstet. 2018;140(3):265–73.PubMedCrossRef

Jauniaux E, Grønbeck L, Bunce C, Langhoff-Roos J, Collins SL. Epidemiology of placenta previa accreta: a systematic review and meta-analysis. BMJ Open. 2019;9(11):e031193.PubMedPubMedCentralCrossRef

Seif KEKJ, Tadbiri H, Turan OM. Neonatal outcomes in pregnancies complicated by Placenta Accreta Spectrum. AJOG. 2022;226(1):749–50.CrossRef

Shamshirsaz AA, Fox KA, Salmanian B, Diaz-Arrastia CR, Lee W, Baker BW, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol. 2015;212(2):218e1–9.CrossRef

10.

Seoud MA, Nasr R, Berjawi GA, Zaatari GS, Seoud TM, Shatila AS, et al. Placenta accreta: elective versus emergent delivery as a major predictor of blood loss. J Neonatal Perinatal Med. 2017;10(1):9–15.PubMedCrossRef

11.

Higgins N, Patel SK, Toledo P. Postpartum Hemorrhage revisited: new challenges and solutions. Curr Opin Anaesthesiol. 2019;32(3):278–84.PubMedCrossRef

12.

Magann EF, Evans S, Hutchinson M, Collins R, Howard BC, Morrison JC. Postpartum Hemorrhage after vaginal birth: an analysis of risk factors. South Med J. 2005;98(4):419–22.PubMedCrossRef

13.

Neary C, Naheed S, McLernon DJ, Black M. Predicting risk of postpartum haemorrhage: a systematic review. BJOG. 2021;128(1):46–53.PubMedCrossRef

14.

Nyfløt LT, Sandven I, Stray-Pedersen B, Pettersen S, Al-Zirqi I, Rosenberg M, et al. Risk factors for severe postpartum Hemorrhage: a case-control study. BMC Pregnancy Childbirth. 2017;17(1):17.PubMedPubMedCentralCrossRef

15.

Oyelese Y, Ananth CV. Postpartum Hemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol. 2010;53(1):147–56.PubMedCrossRef

16.

Schlembach D, Helmer H, Henrich W, von Heymann C, Kainer F, Korte W, et al. Peripartum Haemorrhage, diagnosis and therapy. Guideline of the DGGG, OEGGG and SGGG (S2k level, AWMF Registry No. 015/063, March 2016). Geburtshilfe Frauenheilkd. 2018;78(4):382–99.PubMedPubMedCentralCrossRef

17.

Edwards HM. Aetiology and treatment of severe postpartum haemorrhage. Dan Med J. 2018;65(3).

18.

Surbek D, Vial Y, Girard T, Breymann C, Bencaiova GA, Baud D, et al. Patient blood management (PBM) in pregnancy and Childbirth: literature review and expert opinion. Arch Gynecol Obstet. 2020;301(2):627–41.PubMedCrossRef

19.

Wright JD, Pri-Paz S, Herzog TJ, Shah M, Bonanno C, Lewin SN, et al. Predictors of massive blood loss in women with placenta accreta. Am J Obstet Gynecol. 2011;205(1):38e1–6.CrossRef

20.

Combs CA, Murphy EL, Laros RK. Jr. Factors associated with postpartum Hemorrhage with vaginal birth. Obstet Gynecol. 1991;77(1):69–76.PubMed

21.

Sosa CG, Althabe F, Belizán JM, Buekens P. Risk factors for postpartum Hemorrhage in vaginal deliveries in a latin-american population. Obstet Gynecol. 2009;113(6):1313–9.PubMedPubMedCentralCrossRef

22.

Sheiner E, Sarid L, Levy A, Seidman DS, Hallak M. Obstetric risk factors and outcome of pregnancies complicated with early postpartum Hemorrhage: a population-based study. J Matern Fetal Neonatal Med. 2005;18(3):149–54.PubMedCrossRef

23.

Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum Hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110(5):1368–73.PubMedCrossRef

24.

Chandraharan E, Krishna A. Diagnosis and management of postpartum haemorrhage. BMJ. 2017;358:j3875.PubMedCrossRef

25.

Hecht JL, Baergen R, Ernst LM, Katzman PJ, Jacques SM, Jauniaux E, et al. Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel. Mod Pathol. 2020;33(12):2382–96.PubMedCrossRef

26.

Wortman AC, Alexander JM. Placenta accreta, increta, and percreta. Obstet Gynecol Clin North Am. 2013;40(1):137–54.PubMedCrossRef

27.

Hypertension in pregnancy. Report of the American College of Obstetricians and gynecologists’ Task Force on Hypertension in pregnancy. Obstet Gynecol. 2013;122(5):1122–31.

28.

Coustan DR, Lowe LP, Metzger BE. The hyperglycemia and adverse pregnancy outcome (HAPO) study: can we use the results as a basis for change? J Matern Fetal Neonatal Med. 2010;23(3):204–9.PubMedCrossRef

29.

Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of Diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.PubMedCrossRef

30.

Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PM, Damm P, et al. The diagnosis of gestational Diabetes Mellitus: new paradigms or status quo? J Matern Fetal Neonatal Med. 2012;25(12):2564–9.PubMedCrossRef

31.

Cundy T. Proposed new diagnostic criteria for gestational diabetes–a pause for thought? Diabet Med. 2012;29(2):176–80.PubMedCrossRef

32.

Tsu VD, Langer A, Aldrich T. Postpartum Hemorrhage in developing countries: is the public health community using the right tools? Int J Gynaecol Obstet. 2004;85(Suppl 1):42–51.CrossRef

33.

Andrikopoulou M, D’Alton ME. Postpartum Hemorrhage: early identification challenges. Semin Perinatol. 2019;43(1):11–7.PubMedCrossRef

34.

Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017;95(7):442–9.PubMed

35.

Watkins EJ, Stem K. Postpartum Hemorrhage. Jaapa. 2020;33(4):29–33.PubMedCrossRef

36.

Abdul-Kadir R, McLintock C, Ducloy AS, El-Refaey H, England A, Federici AB, et al. Evaluation and management of postpartum Hemorrhage: consensus from an international expert panel. Transfusion. 2014;54(7):1756–68.PubMedCrossRef

37.

McLintock C, James AH. Obstetric Hemorrhage. J Thromb Haemost. 2011;9(8):1441–51.PubMedCrossRef

38.

Wasserstein RL, Lazar NA. The ASA Statement on p-Values: context, process, and purpose. Am Stat. 2016;70(2):129–33.CrossRef

39.

Bencaiova G, Burkhardt T, Beinder E. Abnormal placental invasion experience at 1 center. J Reprod Med. 2007;52(8):709–14.PubMed

40.

Tinari S, Buca D, Cali G, Timor-Tritsch I, Palacios-Jaraquemada J, Rizzo G, et al. Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021;57(6):903–9.PubMedCrossRef

41.

Esh-Broder E, Ariel I, Abas-Bashir N, Bdolah Y, Celnikier DH. Placenta accreta is associated with IVF pregnancies: a retrospective chart review. BJOG. 2011;118(9):1084–9.PubMedCrossRef

42.

Karami M, Jenabi E, Fereidooni B. The association of placenta previa and assisted reproductive techniques: a meta-analysis. J Matern Fetal Neonatal Med. 2018;31(14):1940–7.PubMedCrossRef

43.

Carusi DA. The Placenta Accreta Spectrum: epidemiology and risk factors. Clin Obstet Gynecol. 2018;61(4):733–42.PubMedCrossRef

44.

Kaser DJ, Melamed A, Bormann CL, Myers DE, Missmer SA, Walsh BW, et al. Cryopreserved embryo transfer is an Independent risk factor for placenta accreta. Fertil Steril. 2015;103(5):1176–84e2.PubMedCrossRef

45.

Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS ONE. 2012;7(12):e52893.PubMedPubMedCentralCrossRef

Title: Risk factors for postpartum haemorrhage in women with histologically verified placenta accreta spectrum disorders: a retrospective single-centre cross-sectional study
Authors: Naghmeh Ghaem Maghami
Fabrice Helfenstein
Gwendolin Manegold-Brauer
Gabriela Amstad
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Sectio Caesarea
Sectio Ceasarea
Abrasio Uteri
Uterine Surgery
Published in: BMC Pregnancy and Childbirth / Issue 1/2023
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-023-06103-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for postpartum haemorrhage in women with histologically verified placenta accreta spectrum disorders: a retrospective single-centre cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Study registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Study registration

Please log in to get access to this content

Other articles of this Issue 1/2023

Revisiting fertility regulation and family ties in Tunisia

Indirect effects of the COVID-19 pandemic on risk of gestational diabetes and factors contributing to increased risk in a multiethnic population: a retrospective cohort study

How much do pregnant women know about the importance of oral health in pregnancy? Questionnaire-based survey

Development and validation of a prognosis risk score model for preterm birth among pregnant women who had antenatal care visit, Northwest, Ethiopia, retrospective follow-up study

Postnatal care service utilisation for babies within the first two months after childbirth: an analysis of rural-urban differences in eleven Sub-Saharan African countries

Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study