Related Experiment Video
Updated: Oct 13, 2025
04:08
Mouse Model of Surgical Uterine Injury and Subsequent Pregnancy Outcomes
Published on: June 27, 2025
563
Potentially Preventable Primary Cesarean Sections in Future Placenta Accreta Spectrum.
Kathy C Matthews1, Andrew S Quinn1, Stephen T Chasen1
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York Presbyterian-Weill Cornell Medicine, New York, New York.
American Journal of Perinatology
|November 16, 2021
Summary
Approximately half of placenta accreta spectrum cases followed a primary cesarean section that may have been preventable. These preventable cesarean deliveries were often performed without clear medical indication, highlighting opportunities to reduce future cases of placenta accreta spectrum.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Outcomes Research
Background:
- Prior cesarean delivery is a significant risk factor for placenta accreta spectrum (PAS) disorders.
- While some primary cesarean sections are medically necessary, others may not have clear indications, potentially increasing PAS risk.
Purpose of the Study:
- To determine the proportion of PAS cases associated with potentially preventable primary cesarean sections.
- To identify factors linked to preventable PAS cases.
Main Methods:
- Retrospective cohort study of women with pathology-confirmed PAS from 2007-2019.
- Primary cesarean sections were classified as preventable or unpreventable based on ACOG-SMFM guidelines.
- Statistical analysis included Fisher's exact test and Mann-Whitney U-test.
Main Results:
- Of 57 PAS patients with prior cesarean delivery, 50.9% had a potentially preventable primary cesarean section.
- Preventable sections were often performed without clear medical indication (37.9%) or for malpresentation without attempted external cephalic version (37.9%).
- Privately insured patients were more likely to have a potentially preventable primary cesarean section (62.5%) compared to Medicaid patients (23.5%).
Conclusions:
- A substantial proportion of placenta accreta spectrum cases may be linked to preventable primary cesarean sections.
- Lack of clear medical indication and failure to attempt external cephalic version were key factors in preventable primary cesarean sections.
- Targeted interventions at patient, provider, and hospital levels are needed to reduce potentially preventable primary cesarean sections and subsequent PAS.
