Archives of Gynecology and Obstetrics

, Volume 297, Issue 5, pp 1151–1156 | Cite as

The risk of placenta accreta following primary cesarean delivery

  • Gil Zeevi
  • Dan Tirosh
  • Joel Baron
  • Maayan Yitshak Sade
  • Adi Segal
  • Reli Hershkovitz
Maternal-Fetal Medicine
  • 87 Downloads

Abstract

Objective

To (a) evaluate the risk for placenta accreta following primary cesarean section (CS), in regard to the stage of labor, the cesarean section was taken (elective prelabor vs. unplanned during labor); and (b) investigate whether the association between placenta accreta and maternal and neonatal complications is modified by the type of the primary CS.

Study design

In a population-based retrospective cohort study, we included all singleton deliveries occurred in Soroka University Medical Center between 1991 and 2015, of women who had a history of a single CS. The deliveries were divided into three groups according to the delivery stage the primary CS was carried out: ‘Unplanned 1’ (first stage—up to 10 cm), ‘Unplanned 2’ (second stage—10 cm) and ‘Elective’ prelabor CS. We assessed the association between the study group and placenta accreta using logistic generalized estimation equation (GEE) models. We additionally assessed maternal and neonatal complications associated with placenta accreta among women who had elective and unplanned CS separately.

Results

We included 22,036 deliveries to 13,727 women with a history of one CS, of which 0.9% (n = 207) had placenta accreta in the following pregnancies: 12% (n = 25) in the ‘Unplanned 1’ group, 7.2% (n = 15) in the ‘ Unplanned 2’ group and 80.8% (n = 167) in the ‘elective’ group. We found no difference in the risk for subsequent placenta accreta between the groups. In a stratified analysis by the timing of the primary cesarean delivery, the risk for maternal complications, associated with placenta accreta, was more pronounced among women who had an unplanned CS (OR 27.96, P < 0.01) compared to women who had an elective cesarean delivery (OR 13.72, P < 0.01).

Conclusions

The stage in which CS is performed has no influence on the risk for placenta accreta in the following pregnancies, women who had an unplanned CS are in a higher risk for placenta accrete-associated maternal complications. This should be taken into consideration while counselling women about their risk while considering trial of labor after cesarean section.

Keywords

Placenta accreta Cesarean section 

Notes

Acknowledgements

Gil Zeevi wrote the first draft of the manuscript. No honorarium, Grant, or other form of payment was given to anyone to produce the manuscript.

Author contributions

GZ: data collection, manuscript writing. RH: project development and management, manuscript editing. DT: manuscript editing, project management. JB: project development and consultant. MYS: data analysis (lead). AS: data collection (support), data analysis

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

Financial disclosures

No financial disclosures.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was obtained by the review board of the Soroka University Medical Center.

Human rights and participant statement

This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Eshkoli T, Weintraub AY, Sergienko R, Sheiner E (2013) Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 208(3):219.e1–219.e7 (Elsevier Inc.) CrossRefGoogle Scholar
  2. 2.
    Vinograd A, Wainstock T, Mazor M, Mastrolia SA, Beer-Weisel R, Klaitman V et al (2015) A prior placenta accreta is an independent risk factor for post-partum hemorrhage in subsequent gestations. Eur J Obstet Gynecol Reprod Biol 187:20–24CrossRefPubMedGoogle Scholar
  3. 3.
    Oyelese Y, Smulian JC (2006) Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 107:927–941CrossRefPubMedGoogle Scholar
  4. 4.
    Tantbirojn P, Crum CP, Parast MM (2008) Pathophysiology of placenta acreta: the role of decidua and extravillous trophoblast. Placenta 29:639CrossRefPubMedGoogle Scholar
  5. 5.
    Committee on Obstetric Practice (2012) Committee opinion no. 529: placenta accreta. Obstet Gynecol 120(1):207–211CrossRefGoogle Scholar
  6. 6.
    Comstock CH (2005) Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol 26:89–96CrossRefPubMedGoogle Scholar
  7. 7.
    Perez-Delboy A, Wright JD (2014) Surgical management of placenta accreta: to leave or remove the placenta? BJOG 121:163–169 (discussion 169–170) CrossRefPubMedGoogle Scholar
  8. 8.
    Lin K, Qin J, Xu K et al (2015) Methotrexate management for placenta accreta: a prospective study. Arch Gynecol Obstet 291:1259–1264CrossRefPubMedGoogle Scholar
  9. 9.
    Clark SL, Koonings PP, Phelan JP (1985) Placenta previa/accreta and prior cesarean section. Obstet Gynecol 66:89–92PubMedGoogle Scholar
  10. 10.
    Chattopadhyay SK, Kharif H, Sherbeeni MM (1993) Placenta praevia and accreta after previous caesarean section. Eur J Obstet Gynecol Reprod Biol 52(3):151–156CrossRefPubMedGoogle Scholar
  11. 11.
    Kamara M, Henderson JJ, Doherty DA et al (2013) The risk of placenta accreta following primary elective caesarean delivery: a case–control study. BJOG 120:879–886CrossRefPubMedGoogle Scholar
  12. 12.
    Son G, Kwon J, Cho H, Kim S, Yoon B, Nam E et al (2007) A case of placenta increta presenting as delayed postabortal intraperitoneal bleeding in the first trimester. J Korean Med Sci 22:932–935CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Belachew J, Cnattingius S, Mulic-Lutvica A, Eurenius K, Axelsson O, Wikstrom A (2014) Risk of retained placenta in women previously delivered by caesarean section: a population-based cohort study. BJOG 121:224–229CrossRefPubMedGoogle Scholar
  14. 14.
    Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y (2002) Placenta accreta–summary of 10 years: a survey of 310 cases. Placenta 23:210–214CrossRefPubMedGoogle Scholar
  15. 15.
    Wehrum MJ, Buhimschi IA, Salafia C (2011) Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 204:411.e1–411.e11CrossRefGoogle Scholar
  16. 16.
    Thomson AJ, Telfer JF, Young A, Campbell S, Stewart CT, Cameron IT, Greer IA, Norman JE (1999) Leukocytes infiltrate the myometrium during human parturition: further evidence that labour is an inflammatory process. Hum Reprod 14:229–236CrossRefPubMedGoogle Scholar
  17. 17.
    Osman I, Young A, Ledingham MA et al (2003) Leukocyte density and pro-inflammatory cytokine expression in human fetal membranes, decidua, cervix and myometrium before and during labour at term. Mol Hum Reprod 9:41–45CrossRefPubMedGoogle Scholar
  18. 18.
    Garmi G, Salim R (2012) Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet Gynecol Int. 2012:873929CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Balayla J, Bondarenko HD (2013) Placenta accreta and the risk of adverse maternal and neonatal outcomes. J Perinat Med 41:141–149CrossRefPubMedGoogle Scholar
  20. 20.
    Taylor LK, Simpson JM, Roberts CL, Olive EC, Henderson-Smart DJ (2005) Risk of complications in a second pregnancy following caesarean section in the first pregnancy: a population-based study. Med J Aust 183:515–519PubMedGoogle Scholar
  21. 21.
    Pallasmaa N, Ekblad U, Gissler M (2008) Severe maternal morbidity and the mode of delivery. Acta Obstet Gynecol Scand 87:662–668CrossRefPubMedGoogle Scholar
  22. 22.
    Arlier S, Seyfettinoğlu S, Yilmaz E, Nazik H, Adıgüzel C, Eskimez E, Hürriyetoğlu Ş (2017) Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section. Arch Gynecol Obstet 295(2):303–311CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.US Unit, Department of Obstetrics and GynecologyBen Gurion University of the NegevBeer ShevaIsrael
  2. 2.Clinical Research Center, Soroka University Medical Center, Faculty of Health SciencesBen Gurion University of the NegevBeer ShevaIsrael

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