Pregnancy Outcomes after Uterine Preservation Surgery for Placenta Accreta Spectrum: A Retrospective Cohort Study.

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

American journal of perinatology Pub Date : 2025-01-01 Epub Date: 2024-06-10 DOI:10.1055/s-0044-1787543

Aviran Ohayon, Elias Castel, Lior Friedrich, Nitzan Mor, Gabriel Levin, Raanan Meyer, Shlomi Toussia-Cohen

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Abstract

Objective: This study aimed to investigate maternal and neonatal outcomes in subsequent pregnancies of women with a history of placenta accreta spectrum (PAS) compared with women without history of PAS.

Study design: A retrospective cohort study conducted at a single tertiary center between March 2011 and January 2022. We compared women with a history of PAS who had uterine preservation surgery and a subsequent pregnancy, to a control group matched in a 1:5 ratio. The primary outcome was the occurrence of a composite adverse outcome (CAO) including any of the following: uterine dehiscence, uterine rupture, blood transfusion, hysterectomy, neonatal intensive care unit admission, and neonatal mechanical ventilation. Multivariable logistic regression was performed to evaluate associations with the CAO.

Results: During the study period, 287 (1.1%) women were diagnosed with PAS and delivered after 25 weeks of gestation. Of these, 32 (11.1%) women had a subsequent pregnancy that reached viability. These 32 women were matched to 139 controls. There were no significant differences in the baseline characteristics between the study and control groups. Compared with controls, the proportion of CAO was significantly higher in women with previous PAS pregnancy (40.6 vs. 19.4%, p = 0.019). In a multivariable logistic regression analysis, previous PAS (adjusted odds ratio [aOR] = 3.31, 95% confidence interval [CI] = 1.09-10.02, p = 0.034) and earlier gestational age at delivery (aOR = 3.53, 95% CI = 2.27-5.49, p < 0.001) were independently associated with CAOs.

Conclusion: A history of PAS in a previous pregnancy is associated with increased risk of CAOs in subsequent pregnancies.

Key points: · The uterine-preserving approach for PAS delivery is gaining more attention and popularity in recent years.. · Women with a previous pregnancy with PAS had higher rates of CAOs in subsequent pregnancies.. · Previous PAS pregnancy is an independent factor associated with adverse outcomes..

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胎盘缺失频谱子宫保留手术后的妊娠结局：回顾性队列研究

研究目的本研究旨在调查有胎盘早剥史（PAS）的妇女与无胎盘早剥史的妇女相比，其后续妊娠的产妇和新生儿结局：研究设计：2011年3月至2022年1月期间在一家三级医疗中心进行的回顾性队列研究。我们将接受过子宫保留手术并随后怀孕的有 PAS 病史的妇女与按 1:5 比例匹配的对照组进行了比较。主要结果是综合不良结局（CAO）的发生率，包括以下任何一项：子宫开裂、子宫破裂、输血、子宫切除、新生儿重症监护病房住院和新生儿机械通气。研究人员进行了多变量逻辑回归，以评估与 CAO 的相关性：在研究期间，有 287 名（1.1%）产妇被诊断为 PAS，并在妊娠 25 周后分娩。其中，有 32 名（11.1%）妇女的后续妊娠达到了存活期。这 32 名妇女与 139 名对照组妇女进行了配对。研究组和对照组的基线特征无明显差异。与对照组相比，曾妊娠过 PAS 的妇女患 CAO 的比例明显更高（40.6% 对 19.4%，P = 0.019）。在多变量逻辑回归分析中，既往有 PAS（调整后的几率比 [aOR] = 3.31，95% 置信区间 [CI] = 1.09-10.02，p = 0.034）和较早的分娩孕龄（aOR = 3.53，95% CI = 2.27-5.49，p 结论：既往有 PAS 史的产妇的 CAO 比例明显高于对照组：前次妊娠中的 PAS 史与后续妊娠中 CAOs 风险的增加有关：- 要点：保宫分娩法近年来越来越受到关注和欢迎。- 曾妊娠过PAS的妇女在随后的妊娠中发生CAO的比例较高。- 前次PAS妊娠是导致不良结局的一个独立因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.