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An observation study of the emergency intervention in placenta accreta spectrum

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

This study explored the probability and outcome of delivery in women with placenta accreta spectrum (PAS) according to gestational age at delivery.

Methods

A retrospective cohort study among women with PAS who had cesarean section was conducted. The gestational week (gw) of delivery and estimated blood loss (EBL) were recorded. The proportion of urgent delivery beyond 32 gw and EBL in women with or without antepartum suspected diagnosis of placenta accreta was compared.

Results

Totally, 180 women with PAS were enrolled. Of these, 54 (30.0%, 95% CI 23.8–37.1%) were delivered by urgent cesarean delivery and 126 (70.0%, 95% CI 62.9–76.2%) by elective cesarean section. The probability of emergent delivery was increased from 3.1 to 5.7% at 33–36 weeks, and increased by > 10% beyond 37 weeks. Among 121 antenatal suspected PAS patients, 25 (20.7%, 95% CI 14.4–28.7%) had emergency cesarean section, and 96 (79.3%, 95% CI 71.3–85.6%) experienced elective cesarean. The EBL of PAS in both emergent group (r =  − 0.276, p = 0.044) and elective group (r =  − 0.370, p < 0.001) was significantly decreased with gestational age progression. The antepartum hemorrhage increased the risk of urgent delivery [OR 2.54 (1.19, 5.44)] (p = 0.016), while PAS with antepartum diagnosis decreased the risk [OR 0.21 (0.10, 0.43)] (p < 0.001).

Conclusion

Although the incidence of emergency operation in PAS patients was increased at 32–36 gw, there was no significant difference among the groups. The decision of timing for pregnancy termination should be made cautiously. We recommend scheduled operation at around 36–37 gw. In serious cases, the termination time could be arranged as early as appropriate.

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Funding

This work was fund by the National Key R&D program of China, 2016YFC1000404.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China

    Yan Wang, Lin Zeng, Ziru Niu, Yiwen Chong, Aiqing Zhang & Yangyu Zhao

  2. Department of Obstetrics and Gynaecology Monash, University Monash Medical Centre, Melbourne, Australia

    Ben Mol

Authors
  1. Yan Wang
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  2. Lin Zeng
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  3. Ziru Niu
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  4. Yiwen Chong
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  5. Aiqing Zhang
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  6. Ben Mol
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  7. Yangyu Zhao
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Contributions

Prof. YZ and Dr. YW design the study and wrote the manuscript. Dr. LZ and Dr. ZN collected the data, analysis the data, and wrote the manuscript. Dr. YC and Dr. AZ done the ultrasound and analyzed the data of this study. Prof. BM analyzed the data and wrote the manuscript.

Corresponding author

Correspondence to Yangyu Zhao.

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The authors declared that they have no conflicts of interest to this work.

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Wang, Y., Zeng, L., Niu, Z. et al. An observation study of the emergency intervention in placenta accreta spectrum. Arch Gynecol Obstet 299, 1579–1586 (2019). https://doi.org/10.1007/s00404-019-05136-6

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  • DOI: https://doi.org/10.1007/s00404-019-05136-6

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