Clinical Risk Factors for Placenta Accreta or Placenta Percreta: A Case-Control Study

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Outcomes Research

Background:

• Uterine scarring from prior cesarean delivery is a known risk factor for placenta accreta spectrum (PAS) disorder.
• PAS is associated with significant maternal morbidity, including the need for hysterectomy.

Purpose of the Study:

• To identify specific risk factors for PAS in women with a history of cesarean delivery.
• To inform clinical practice and patient counseling regarding PAS risk.

Main Methods:

• A case-control study was conducted, comparing women who underwent hysterectomy for PAS (cases) with women who had a previous cesarean delivery (controls).
• Maternal and previous cesarean characteristics were analyzed using univariate and multivariate logistic regression.

Main Results:

• History of uterine surgery (OR 27.4) and number of previous cesareans (OR 7.2-7.9) were strongly associated with PAS.
• In women with one prior cesarean, an interdelivery interval <18 months (OR 6.3) and smoking (OR 5.8) were significant risk factors.
• Gestational age and cervical dilation at prior cesarean were not associated with PAS.

Conclusions:

• Previous uterine surgery, multiple cesarean deliveries, smoking, and short interdelivery intervals are significant risk factors for PAS requiring hysterectomy.
• Further research is needed to assess the impact of uterine closure techniques during prior cesareans on PAS risk.