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Placenta accreta/increta/percreta: incidence, risk factors, management and outcomes
  1. KE Fitzpatrick1,
  2. S Sellers2,
  3. P Spark1,
  4. JJ Kurinczuk1,
  5. P Brocklehurst1,
  6. M Knight1
  1. 1National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
  2. 2St Michael's Hospital, Bristol, United Kingdom

Abstract

Objective To estimate the incidence and describe the risk factors, management and outcomes of placenta accreta/increta/percreta.

Methods A national population-based case-control study was undertaken using the UK Obstetric Surveillance System between May 2010-April 2011. Participants comprised 134 women with placenta accreta/increta/percreta and 258 controls.

Results The estimated incidence of placenta accreta/increta/percreta was 1.7 per 10,000 maternities (95%CI 1.4-2.0). Older women had raised odds of having placenta accreta/increta/percreta (aOR 3.3, 95%CI 1.4-7.6 in women 35+yrs) as did women who had a previous caesarean (aOR 14.2, 95%CI 5.5-36.5), other previous uterine surgery (aOR 2.8, 95%CI 1.1-7.7), placenta praevia diagnosed antepartum (aOR 69.5, 95%CI 17.7–273.0) and an IVF pregnancy (aOR 43.8, 95%CI 2.7–699.5). Placenta accreta/increta/percreta was suspected in 50% of women antenatally. Of the 27(20%) women who had their complete placenta left in situ, 15(56%) had a hysterectomy. Of the 107(80%) women who did not have their complete placenta left in situ, 63(59%) had a hysterectomy. Overall, 61% had other therapies to treat haemorrhage prior to hysterectomy and 5% had methotrexate used. There were no maternal deaths, but women with placenta accreta/increta/percreta were more likely to deliver preterm (aOR 16.9, 95%CI 7.5–38.1) and 70% were admitted to ITU/HDU.

Conclusions Placenta accreta/increta/percreta is uncommon but associated with preterm delivery and significant maternal morbidity. This study confirms previously reported associations including with prior caesarean delivery; the association with IVF pregnancy requires confirmation in other studies. Treatment varied and further investigation of the clinical effectiveness of different management strategies is warranted.

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