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Risk factors and clinical outcomes for placenta accreta spectrum with or without placenta previa

Archives of Gynecology and Obstetrics volume 305, pages 607–615 (2022)Cite this article

Abstract

Purpose

To clarify risk factors and clinical outcomes for placenta accreta spectrum (PAS) stratified by placenta previa.

Methods

We conducted registry-based multicenter cross-sectional study including 472,301 singleton deliveries between 2013 and 2015. PAS was considered as a primary outcome, as well as maternal age, parity, history of cesarean section, history of miscarriage, and assisted reproductive technology (ART) were considered as potential exposures. A multivariable Poisson regression analysis was conducted to assess the risk for PAS, stratified by placenta previa. In addition, the risk for subsequent blood transfusion and hysterectomy by each exposure using multivariable Poisson regression analysis was conducted.

Results

There were 426 and 1827 cases of PAS with and without placenta previa. Among cases with placenta previa, the number of previous cesarean sections was the most powerful predictor for PAS [adjusted risk ratio (aRR) for one previous cesarean section 5.34, 95% confidence interval (CI) 3.70–7.71; aRR for two or more previous cesarean section 16.5, 95% CI 11.5–23.6]. Among cases without placenta previa, previous cesarean section was not a significant predictor, whereas the strongest predictor was conception through ART (aRR 5.05, 95% CI 4.50–5.66). Although the risks of PAS for blood transfusion and hysterectomy were higher among cases with placenta previa, those without placenta previa also demonstrated non-negligible risks.

Conclusion

The current study demonstrated that history of cesarean section was the strongest risk factor for PAS among women with placenta previa. Among those without placenta previa, ART was an important predictor, but not cesarean section.

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Fig. 1

Availability of data and materials

The data that support the findings of this study are available from the Japan Society of Obstetrics and Gynecology but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the Japan Society of Obstetrics and Gynecology.

Code availability

STATA custom code cannot be shared publicly, but it is available on request from Kohei Ogawa (ogawa-k@ncchd.go.jp).

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Acknowledgements

We thank the Japan Society of Obstetrics and Gynecology Perinatal Committee as well as all participating hospitals for the provision of the data used. In addition, we would like to thank the medical editor from the Division of Education for Clinical Research at the National Center for Child Health and Development for editing this manuscript.

Funding

No specific funding was obtained.

Author information

Authors and Affiliations

  1. Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Kohei Ogawa & Haruhiko Sago

  2. Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Kohei Ogawa & Naho Morisaki

  3. Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan

    Seung Chik Jwa

Authors
  1. Kohei Ogawa
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  2. Seung Chik Jwa
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  3. Naho Morisaki
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  4. Haruhiko Sago
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Contributions

KO initiated the concept, designed the study, analyzed the data, and wrote the initial manuscript. SJ, NM, and SH gave critical comments on the study design, analysis, and interpretation, as well as revised the draft.

Corresponding author

Correspondence to Kohei Ogawa.

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Conflict of interest

All authors declare that they have no conflicts of interest associated with the publication of this research.

Ethical approval

The registry of the Japan Society of Obstetrics and Gynecology Perinatal Database was conducted in accordance with the guidelines of the Declaration of Helsinki and other nationally valid regulations. All participating hospitals posted that they were participating in this database and that all data would be included in the research unless noted by the physician as otherwise. The JSOG website posted a summary of all analytical studies, and each hospital notified the patients to contact their hospital if they did not want to be included. The protocol for this study was approved by the Institutional Review Board at the National Center for Child Health and Development on April 18, 2017 (No. 1448).

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Cite this article

Ogawa, K., Jwa, S.C., Morisaki, N. et al. Risk factors and clinical outcomes for placenta accreta spectrum with or without placenta previa. Arch Gynecol Obstet 305, 607–615 (2022). https://doi.org/10.1007/s00404-021-06189-2

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  • DOI: https://doi.org/10.1007/s00404-021-06189-2

Keywords

  • Assisted reproductive technology
  • History of cesarean section
  • Placenta accreta spectrum
  • Placenta previa