Outcomes of Subsequent Births After Placenta Accreta Spectrum

Area of Science:

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

Background:

• Placenta accreta spectrum (PAS) is a severe obstetric complication with potential for significant maternal morbidity.
• Understanding the risks associated with subsequent pregnancies after PAS is crucial for patient counseling and management.

Purpose of the Study:

• To investigate subsequent birth rates and maternal-neonatal outcomes in women with a history of placenta accreta spectrum.
• To compare outcomes between women with and without a history of PAS, controlling for risk factors.

Main Methods:

• A population-based record linkage study in New South Wales (2003-2016) included women with first, second, or third births.
• Women with PAS history were propensity score-matched to controls. Modified Poisson regression analyzed maternal and neonatal outcomes.

Main Results:

• Recurrent PAS occurred in 4.7% of second and 7.6% of third pregnancies post-PAS. Overall recurrence was 5.5%.
• Subsequent births after PAS showed increased risks of postpartum hemorrhage (aRR 1.51), transfusion (aRR 2.13), cesarean delivery (aRR 1.19), manual placental removal (aRR 6.92), and preterm birth (aRR 1.43).
• A lower risk of small for gestational age infants (aRR 0.64) was observed in subsequent pregnancies post-PAS.

Conclusions:

• Women with a history of PAS have elevated risks of maternal morbidity, preterm birth, and PAS recurrence in future pregnancies.
• While absolute risks are generally low, these findings highlight the importance of informed counseling for women regarding future pregnancy outcomes.
• The study provides evidence to guide clinical management and patient education for women with a history of placenta accreta spectrum.