Risk of Placenta Accreta Spectrum Disorder After Prior Non-Cesarean Delivery Uterine Surgery: A Systematic Review and Meta-analysis.

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Obstetrics and gynecology Pub Date : 2025-06-01 Epub Date: 2025-02-06 DOI:10.1097/AOG.0000000000005824

Ru Yang, Lizi Zhang, Lu Sun, Jianli Wu, Shilei Bi, Miao Hu, Shijun Luo, Fang He, Jingsi Chen, Lin Yu, Qiying Zhu, Dunjin Chen, Lili Du

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引用次数: 0

Abstract

Objective: To evaluate the association between previous non-cesarean uterine surgery and placenta accreta spectrum (PAS) in subsequent pregnancies.

Data sources: PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov , CNKI (China National Knowledge Infrastructure), and Wan-fang Database were searched from inception to April 2024, supplemented by manual searches.

Methods of study selection: Studies included prospective, retrospective cohort, case-control, and cross-sectional studies involving pregnant women diagnosed with PAS and reporting at least one risk factor associated with previous uterine surgery.

Tabulation, integration, and results: Two authors independently screened potentially eligible studies and extracted data. The quality of the studies was assessed with the Newcastle-Ottawa Scale. The pooled odds ratios (ORs), adjusted ORs, and their 95% CIs were estimated with fixed- or random-effects models if the heterogeneity ( I2 ) was high. Sensitivity analyses were conducted to account for potential study bias. The main measures were myomectomy, uterine artery embolization, dilatation and curettage, hysteroscopic adhesiolysis, abortion, endometrial ablation, and operative hysteroscopy. A total of 38 studies involving 7,353,177 participants were included in the systematic review, with an overall prevalence of PAS of 0.16%, and 31 studies were included in the meta-analysis. Prior non-cesarean uterine surgeries were associated with PAS in subsequent pregnancy (pooled OR 2.29, 95% CI, 1.43-3.68). Distinct associations between specific uterine surgery and PAS included myomectomy (OR 2.29, 95% CI, 1.77-2.97), uterine artery embolization (OR 43.16, 95% CI, 20.50-90.88), dilatation and curettage (OR 2.28, 95% CI, 1.78-2.93), hysteroscopic adhesiolysis (OR 7.72, 95% CI, 4.10-14.53), abortion (OR 1.65, 95% CI, 1.43-1.92), endometrial ablation (OR 20.26, 95% CI, 17.15-23.93), and operative hysteroscopy (OR 3.10, 95% CI, 1.86-5.18).

Conclusion: Prior non-cesarean uterine surgery is associated with a significantly increased odds for development of PAS in subsequent pregnancy, and the risk varies depending on the types of uterine surgery.

Systematic review registration: PROSPERO: CRD42024552210.

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既往非剖宫产子宫手术后胎盘增生谱系障碍的风险：系统回顾和荟萃分析。

目的：探讨既往非剖宫产手术与妊娠后胎盘增生谱（PAS）的关系。数据来源：PubMed、EMBASE、Cochrane图书馆、ClinicalTrials.gov、中国知网（CNKI）、万方数据库自成立至2024年4月检索，辅以人工检索。研究选择方法：研究包括前瞻性、回顾性队列、病例对照和横断面研究，涉及诊断为PAS的孕妇，并报告至少一种与既往子宫手术相关的危险因素。制表、整合和结果：两位作者独立筛选了可能符合条件的研究并提取了数据。研究的质量用纽卡斯尔-渥太华量表进行评估。如果异质性（I2）较高，则采用固定效应或随机效应模型估计合并优势比（or）、调整后的or及其95% ci。进行敏感性分析以解释潜在的研究偏倚。主要措施为子宫肌瘤切除、子宫动脉栓塞、扩张刮除、宫腔镜下粘连松解、流产、子宫内膜消融、手术宫腔镜。系统评价共纳入38项研究，涉及7353177名受试者，PAS的总患病率为0.16%，meta分析纳入31项研究。既往非剖宫产手术与随后妊娠的PAS相关（合并OR为2.29,95% CI为1.43-3.68）。特殊子宫手术与PAS的显著相关性包括子宫肌瘤切除术（OR 2.29, 95% CI, 1.77-2.97）、子宫动脉栓塞术（OR 43.16, 95% CI, 20.50-90.88）、子宫扩张和刮除术（OR 2.28, 95% CI, 1.78-2.93）、宫腔镜粘连松解术（OR 7.72, 95% CI, 4.10-14.53）、流产（OR 1.65, 95% CI, 1.43-1.92）、子宫内膜消融术（OR 20.26, 95% CI, 17.15-23.93）和宫腔镜手术（OR 3.10, 95% CI, 1.86-5.18）。结论：既往非剖宫产子宫手术与随后妊娠发生PAS的几率显著增加相关，且风险因子宫手术类型而异。系统评价注册：PROSPERO: CRD42024552210。

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

Obstetrics and gynecology 医学-妇产科学

CiteScore

11.10

自引率

4.20%

发文量

867

审稿时长

1 months

期刊介绍： "Obstetrics & Gynecology," affectionately known as "The Green Journal," is the official publication of the American College of Obstetricians and Gynecologists (ACOG). Since its inception in 1953, the journal has been dedicated to advancing the clinical practice of obstetrics and gynecology, as well as related fields. The journal's mission is to promote excellence in these areas by publishing a diverse range of articles that cover translational and clinical topics. "Obstetrics & Gynecology" provides a platform for the dissemination of evidence-based research, clinical guidelines, and expert opinions that are essential for the continuous improvement of women's health care. The journal's content is designed to inform and educate obstetricians, gynecologists, and other healthcare professionals, ensuring that they stay abreast of the latest developments and best practices in their field.