Interpregnancy interval as a risk factor for placenta accreta

• Published in: Connecticut medicine Vol. 64; no. 11; p. 659
• Main Authors: Wax, J R, Seiler, A, Horowitz, S, Ingardia, C J
• Format: Journal Article
• Language: English
• Published: United States 01.11.2000
• Subjects: Adult; Birth Intervals; Birth Weight; Case-Control Studies; Cesarean Section; Delivery, Obstetric; Female; Humans; Maternal Age; Placenta Accreta - etiology; Pregnancy; Risk Factors; Time Factors
• ISSN: 0010-6178

To determine if the interval from a previous delivery or cesarean to the next conception differs between patients with abnormally adherent placentas as compared to those with normally implanted placentas. We identified all histologically confirmed placentas--accreta, increta, and percreta--at our hospital from 1992-1999. Subjects were excluded for primigravidity in the affected pregnancy or inability to identify matched controls. Cases were matched to the next three consecutive women delivering for maternal age (> or = 35 years or < 35 years), placenta previa (yes or no), prior cesarean (yes or no), prior uterine curettage (yes or no), and prior vaginal delivery (yes or no). The primary outcomes were delivery-to-conception and cesarean-to-conception intervals. Secondary outcomes included measures of maternal and neonatal morbidity. Delivery-to-conception intervals for cases and controls were 37.1 +/- 18.7 months and 37.9 +/- 22.7 months, respectively (P = .91). Cesarean-to-conception intervals for cases and controls were 35.2 +/- 18.2 and 48.1 +/- 31.0 months, respectively (P = .35). Cases were more likely to require uterine curettage (54.5 vs 0%), hysterectomy (81.8 vs 0%), and transfusion (72.7 vs 0%), all P < .001. Subjects with accreta delivered earlier (31.7 +/- 9.4 vs 38.1 +/- 2.6 weeks, P = .054) and smaller infants (2,158 +/- 1,180 g vs 3,159 +/- 781 g, P = .006) who were more likely to have five-minute Apgar scores < 7 (18.2% vs 0%, P = .038). Cesarean-to-conception intervals but not delivery-to-conception intervals are shorter in patients with abnormally adherent placentas. Placenta accreta is associated with significant maternal and perinatal morbidity.