Placenta Accreta Spectrum: Epidemiology, Risk Determinants, and Clinical Consequences in Benghazi Medical Centre -2022.
DOI:
https://doi.org/10.37376/benunivmedj.v2i2.7497Keywords:
Placenta accrete, incidence, Risk factors, complications.Abstract
Abstract
Background: Placenta Accreta Spectrum (PAS) is a pregnancy-related disorder characterized by the abnormal adherence of trophoblastic tissue to the uterine myometrium, posing a significant risk of maternal mortality. Key risk factors for PAS include placenta previa and prior cesarean deliveries, which have been rising in frequency.
Aim: to explore the risk factors of PAS, incidence, clinical outcomes of affected patients, and strategies to minimize maternal morbidity and mortality.
Method: prospective cohort study conducted on 60 patients during the year 2022 in Benghazi Medical Centre including all patients labeled as PAS cases, Review of records for all patients using the structured data collection sheet. The total number of deliveries, caesarean deliveries, maternal and perinatal deaths had been registered; patients were followed up till delivery.
Results: Mean age of the studied group was 35.37±5.70, 43.3 % of them were multipara , 56.7% with previous cesarean section three or more times, 71.7% of the studied group with grade III placenta previa, 95.0% experienced some complication, after multivariate analysis C.S 3 times and more is considered risk factor for hysterectomy (p value = 0.03) ( OR 6.12, 95% CI (1.15-32.59), there was statistical significant association between CS delivery and length of hospital stay (p value =0.005).
Conclusion: Incidence of placenta accreta increases with advanced age, with multipara and with 3 times and more CS. Placenta previa was coexisting factor in 95% of the cases.
Keywords: ,, ,
References
American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric Care Consensus, No.7: Placenta Accreta Spectrum. Obstet. Gynecol. 2018, 132, e259–e275.
Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am. 2015 Jun; 42(2):381-402.
Hecht, J.L.; Baergen, R.; Ernst, L.M.; Katzman, P.J.; Jacques, S.M.; Jauniaux, E.; Khong, T.Y.; Metlay, L.A.; Poder, L.; Qureshi, F.; 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, 2382–2396.
Khong TY. The pathology of placenta accreta, a worldwide epidemic. J Clin Pathol. 2008 Dec;61(12):1243-6.
Mogos MF, Salemi JL, Ashley M, Whiteman VE, Salihu HM. Recent trends in placenta accreta in the United States and its impact on maternal-fetal morbidity and healthcare-associated costs, 1998-2011. J Matern Fetal Neonatal Med. 2016;29(7):1077-82.
Silver RM, Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126(3):654-687.
Adler E, Madankumar R, Rosner M, Reznik SE. Increased placental trophoblast inclusions in placenta accreta. Placenta. 2014 Dec;35(12):1075-8.
Fisher SJ. Why is placentation abnormal in preeclampsia? Am J Obstet Gynecol. 2015;213: S115–22.
Japaraj RP, Mimin TS, Mukudan K. Antenatal diagnosis of placenta previa accreta in patients with previous cesarean scar. J Obstet Gynaecol Res. 2007 Aug; 33(4):431-7.
El Gelany SA, Ibrahim EM, Mohammed MM, et al. Management of bleeding from morbidly adherent placenta during elective repeat caesarean section: retrospective -record-based study. BMC Pregnancy Childbirth. 2019;19(1): 106.
Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, et al. Incidence and risk factors for PAS disorders/increta/Percreta in the UK: a national case-control study. PLoS One. 2012; 7(12):e52893.
Farquhar CM, Li Z, Lensen S, et al. Incidence, risk factors and perinatal outcomes for PAS disorders in Australia and New Zealand: a case–control study. BMJ Open. 2017;7:e017713.
Zhang D, Siqin Y, Yanyan H, Yan S, Haofan S, Wei G. Risk factors, outcome and management survey of PAS disorders in 153 cases: a five-year experience from a hospital of Shanghai, China. Int J Clin Exp Med. 2017;10 (8):12509–16.
Balayla J, Bondarenko HD. PAS disorders and the risk of adverse maternal and neonatal outcomes. J Perinat Med. 2013;41:141–9.
Thurn, L. ∙ Lindqvist, P.G. ∙ Jakobsson, M. ...Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries BJOG. 2016; 123:1348-1355
Miller, D. A., Chollet, J. A. & Goodwin, T. M. Clinical risk factors for placenta previa-placenta accreta. Am. J. Obstet. Gynecol. 1997; 177, 210–214.
Silver, R. M. et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet. Gynecol.2006; 107, 1226–1232.
Bowman ZS, Manuck TA, Eller AG, et al. Risk factors for unscheduled delivery in patients with placenta accreta. Am J Obstet Gynecol 2014; 210(3): 241.e1–241.e6.
Kayem, G. et al. Clinical profiles of placenta accreta spectrum: the PACCRETA population-based study. BJOG 128, 1646–1655 (2021)..
Hessami, K. et al. Clinical correlates of placenta accreta spectrum disorder depending on the presence or absence of placenta previa: A systematic review and meta-analysis. Obstet. Gynecol.2022; 140, 599–606.
Kloka JA, Friedrichson B, Jasny T, Blum LV, Choorapoikayil S, Old O, Zacharowski K, Neef V. Anaemia and red blood cell transfusion in women with placenta accreta spectrum: an analysis of 38,060 cases. Sci Rep. 2024 Feb 29;14(1):4999.
Matalliotakis M, Velegrakis A, Goulielmos GN, Niraki E, Patelarou AE, Matalliotakis I. Association of placenta previa with a history of previous cesarian deliveries and indications for a possible role of a genetic component. Balkan J Med Genet. 2017;20:5–10.
Muñoz M, Peña-Rosas JP, Robinson S, et al. Patient blood management in obstetrics: Management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med. 2018;28(1):22–39.
National institute for Heath and Care Escellence (NICE). Antenatal Care. https://www.nice.org.uk/guidance/ng201/resources/antenatal-care-pdf-66143709695941. (2021).
Birendra R, Jigyasa S. A Retrospective Study of Maternal and Neonatal Outcome in Placenta Accreta Spectrum After Planned or Emergency Delivery From a Tertiary Care Centre in North India. Cureus. 2023 Sep 5;15(9):e44725.
Varlas VN, Bors RG, Birsanu S, Maxim B, Clotea E, Mihailov M. Maternal and fetal outcome in placenta accreta spectrum (PAS) associated with placenta previa: a retrospective analysis from a tertiary center. J Med Life. 2021;14:367–375.
Horgan R, Abuhamad A. Placenta accreta spectrum: Prenatal diagnosis and management. Obstet Gynecol Clin North Am. 2022;49: 423–438.
Bluth A, Schindelhauer A, Nitzsche K, Wimberger P, Birdir C. Placenta accreta spectrum disorders-experience of management in a German tertiary perinatal centre. Arch Gynecol Obstet. 2021;303:1451–1460.
Balayla J, Bondarenko HD. Placenta accreta and the risk of adverse maternal and neonatal outcomes. J Perinat Med. 2013;41:141–149.
Huanyu Y, Yan W, Rui H, Jinyu G, Lin Z, Yangyu Z. Risk factors for placenta accreta spectrum without prior cesarean section: A case–control study in China. 2024;166 (3) :1092-1099.
-Miller HE , Leonard SA , Fox KA , Carusi DA, Lyell DJ. Placenta accreta spectrum among women with twin gestations. Obstet Gynaeco.2021; 137(1): 132- 138 .
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