Risk factors for placenta accreta: a large prospective cohort

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Placenta accreta is a serious obstetric complication.
• Placenta previa and prior cesarean delivery are established risk factors for placenta accreta.
• Identification of additional risk factors is crucial for improved management.

Purpose of the Study:

• To investigate risk factors for placenta accreta in a large, prospective, multicenter cohort.
• To identify maternal characteristics associated with placenta accreta beyond known risk factors.

Main Methods:

• Secondary analysis of a large multicenter cesarean delivery cohort.
• Comparison of women with and without placenta accreta.
• Univariate and multivariate analyses to examine potential risk factors.

Main Results:

• 0.27% of cesarean deliveries (196/73,257) were complicated by placenta accreta.
• Increasing numbers of prior cesarean deliveries correlated with higher accreta risk (p < 0.001).
• Women with placenta previa had a significantly increased risk (adjusted OR, 34.9).
• Among women with previa, two or three prior cesarean deliveries increased accreta risk (adjusted ORs 4.9 and 7.7, respectively).
• No other maternal demographics, prior cesarean details, interval between deliveries, parity, BMI, tobacco use, or coexisting conditions were significantly associated with accreta.

Conclusions:

• The risk of placenta accreta is elevated in patients with placenta previa.
• The risk of placenta accreta escalates with an increasing number of prior cesarean deliveries in the presence of previa.
• No additional maternal characteristics were identified as significant risk factors for placenta accreta in this cohort.