Advertisement

An observation study of the emergency intervention in placenta accreta spectrum

  • Yan Wang
  • Lin Zeng
  • Ziru Niu
  • Yiwen Chong
  • Aiqing Zhang
  • Ben Mol
  • Yangyu ZhaoEmail author
Maternal-Fetal Medicine
  • 32 Downloads

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.

Keywords

Emergency intervention Placenta accreta spectrum Observational study 

Notes

Author 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.

Funding

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

Compliance with ethical standards

Conflict of interest

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

Supplementary material

404_2019_5136_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 13 KB)

References

  1. 1.
    Silver RM (2015) Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 126(3):654–668CrossRefGoogle Scholar
  2. 2.
    Silver RM, Branch DW (2018) Placenta accreta spectrum. N Engl J Med. 378(16):1529–1536CrossRefGoogle Scholar
  3. 3.
    Read JA, Cotton DB, Miller FC (1980) Placenta accreta: changing clinical aspects and outcome. Obstet Gynecol 56:31–34Google Scholar
  4. 4.
    Miller DA, Chollet JA, Goodwin TM (1997) Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 177:210–214CrossRefGoogle Scholar
  5. 5.
    Bailit JL, Grobman WA, Rice MM et al (2015) Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 125:683–689CrossRefGoogle Scholar
  6. 6.
    Wu S, Kocherginsky M, Hibbard JU (2005) Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192:1458–1461CrossRefGoogle Scholar
  7. 7.
    Zhongying D (2008) Nomenclature, incidence and etiology of invasive placenta. J Pract Obstetr Gynecol 12:705–707Google Scholar
  8. 8.
    Warshak CR, Ramos GA, Eskander R, Benirschke K, Saenz CC, Kelly TF et al (2010) Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 115:65–69CrossRefGoogle Scholar
  9. 9.
    Briery CM, Rose CH, Hudson WT, Lutgendorf MA, Magann EF, Chauhan SP et al (2007) Planned vs emergent cesarean hysterectomy. Am J Obstet Gynecol 197(154):e1–5Google Scholar
  10. 10.
    Eller AG, Bennett MA, Sharshiner M et al (2011) Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 117:331–337CrossRefGoogle Scholar
  11. 11.
    Shamshirsaz AA, Fox KA, Salmanian B et al (2015) Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 212(2):218.e1–9CrossRefGoogle Scholar
  12. 12.
    Placenta accreta. Committee Opinion No. 529 (2012) American College of Obstetricians and Gynecologists. Obstet Gynecol 120:207–211.Google Scholar
  13. 13.
    Committee Publications (2010) Society for Maternal-Fetal Medicine, Belfort MA. Placenta accreta. Am J Obstet Gynecol 203:430–439CrossRefGoogle Scholar
  14. 14.
    Wright JD, Silver RM, Bonanno C, Gaddipati S, Lu YS, Simpson LL et al (2013) Practice patterns and knowledge of obstetricians and gynecologists regarding placenta accreta. J Matern Fetal Neonatal Med 26:1602–1609CrossRefGoogle Scholar
  15. 15.
    Esakoff TF, Handler SJ, Granados JM, Caughey AB (2012) PAMUS: placenta accreta management across the United States. J Matern Fetal Neonatal Med 25:761–765CrossRefGoogle Scholar
  16. 16.
    Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y (2002) Placenta accreta–summary of 10 years: a survey of 310 cases. Placenta 23(2–3):210–214CrossRefGoogle Scholar
  17. 17.
    Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K et al (2006) Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 108:573–581CrossRefGoogle Scholar
  18. 18.
    Jolley JA, Nageotte MP, Wing DA, Shrivastava VK (2012) Management of placenta accreta: a survey of Maternal-Fetal Medicine practitioners. J Matern Fetal Neonatal Med 25:756–760CrossRefGoogle Scholar
  19. 19.
    Rac MW, Wells CE, Twickler DM, Moschos E, McIntire DD, Dashe JS (2015) Placenta accreta and vaginal bleeding according to gestational age at delivery. Obstet Gynecol. 125(4):808–813CrossRefGoogle Scholar
  20. 20.
    Wright JD, Pri-Paz S, Herzog TJ, Shah M, Bonanno C, Lewin SN et al (2011) Predictors of massive blood loss in women with placenta accreta. Am J Obstet Gynecol 205(38):e1–6Google Scholar
  21. 21.
    Wright JD, Herzog TJ, Shah M et al (2010) Regionalization of care for obstetric hemorrhage and its effect on maternal mortality. Obstet Gynecol 115:1194–1200CrossRefGoogle Scholar
  22. 22.
    Silver RM, Fox KA, Barton JR et al (2015) Center of excellence for placenta accreta. Am J Obstet Gynecol 212:561–568CrossRefGoogle Scholar
  23. 23.
    Meller CH, Izbizky GH, Otaño L (2014) Timing of delivery in placenta accreta. Am J Obstet Gynecol. 211(4):438–439CrossRefGoogle Scholar
  24. 24.
    Robinson BK, Grobman WA (2010) Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstet Gynecol. 116(4):835–842CrossRefGoogle Scholar
  25. 25.
    Bowman ZS, Manuck TA, Eller AG, Simons M, Silver RM (2014) Risk factors for unscheduled delivery in patients with placenta accreta. Am J Obstet Gynecol 210(241):e1–6Google Scholar
  26. 26.
    Meller CH, Izbizky GH, Otaño L (2014) Timing of delivery in placenta accrete. Am J Obstet GynecolGoogle Scholar
  27. 27.
    Chong Y, Zhang A, Wang Y, Liu Z, Chen Y, Zhao Y (2016) Value of ultrasonic scoring system for predicting risks of placenta accreta. Zhonghua wei chan yi xue za zhi. 19(9):705–709Google Scholar
  28. 28.
    Wang Y, Gao Y, Zhao Y, Chong Y, Chen Y (2018) Ultrasonographic diagnosis of severe placental invasion. J Obstet Gynaecol Res. 44(3):448–455CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina
  2. 2.Department of Obstetrics and Gynaecology MonashUniversity Monash Medical CentreMelbourneAustralia

Personalised recommendations