Neha Agarwal, Edgar A Hernandez-Andrade, Donatella Gerulewicz, Ramesha Papanna, Dejian Lai, Eleazar E Soto Torres, Sarah T Mehl, Elias Kassir, Farah H Amro, Baha M Sibai, Sean C Blackwell
{"title":"既往剖宫产次数与累赘胎盘严重程度谱；推荐中心的经验。","authors":"Neha Agarwal, Edgar A Hernandez-Andrade, Donatella Gerulewicz, Ramesha Papanna, Dejian Lai, Eleazar E Soto Torres, Sarah T Mehl, Elias Kassir, Farah H Amro, Baha M Sibai, Sean C Blackwell","doi":"10.1159/000547755","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the frequency of severe stages of placenta accreta spectrum (PAS) in relation to the number of previous cesarean deliveries (PCDs).</p><p><strong>Design: </strong>We conducted a retrospective cohort study.</p><p><strong>Setting: </strong>The study was carried out at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.</p><p><strong>Participants: </strong>A total of 176 patients with histopathologically confirmed PAS were included in the study. The frequency of each stage of PAS severity was analyzed in relation to the number of PCDs Methods: Differences in the frequency of different stages of PAS severity among patients with varying numbers of PCDs were estimated. Adjusted logistic regression models were used to evaluate the association between the number of PCDs and PAS severity.</p><p><strong>Results: </strong>In our referral center, the frequency of placenta accreta was 18.1% (n = 32/176), placenta increta 55.6% (n = 98/176), and placenta percreta 26.1% (n = 46/176). There were 8 patients with no PCDs, 48 with 1 PCD, 62 with 2 PCDs, and 58 with ≥3 PCDs. The frequency of placenta increta was similar among all PCDs groups; however, the frequency of placenta percreta was significantly higher among women with ≥3 PCDs (25/58 [43.1%]) as compared to those with ≤2 PCDs (21/118 [17.7%], aOR, 3.49 [95% confidence interval, 1.73-7.05]; p = 0.005). Patients with no PCDs had a higher frequency of placenta accreta and a similar frequency of placenta increta to those with a history of PCDs.</p><p><strong>Limitations: </strong>The study was conducted at a single center with a high referral rate for severe forms of PAS, which may restrict the generalizability of the findings. Additionally, the classification of PAS relies heavily on histopathologic interpretation, which can introduce potential biases depending on provider experience and the criteria used.</p><p><strong>Conclusion: </strong>The frequency placenta increta was similar among women with the suspicion of PAS regardless of the number of PCDs. Women with ≥3 PCDs had a significantly higher frequency of placenta percreta.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-7"},"PeriodicalIF":2.3000,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Number of Previous Cesarean Deliveries and Severity of Placenta Accreta Spectrum: A Referral Center Experience.\",\"authors\":\"Neha Agarwal, Edgar A Hernandez-Andrade, Donatella Gerulewicz, Ramesha Papanna, Dejian Lai, Eleazar E Soto Torres, Sarah T Mehl, Elias Kassir, Farah H Amro, Baha M Sibai, Sean C Blackwell\",\"doi\":\"10.1159/000547755\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The objective of this study was to evaluate the frequency of severe stages of placenta accreta spectrum (PAS) in relation to the number of previous cesarean deliveries (PCDs).</p><p><strong>Design: </strong>We conducted a retrospective cohort study.</p><p><strong>Setting: </strong>The study was carried out at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.</p><p><strong>Participants: </strong>A total of 176 patients with histopathologically confirmed PAS were included in the study. The frequency of each stage of PAS severity was analyzed in relation to the number of PCDs Methods: Differences in the frequency of different stages of PAS severity among patients with varying numbers of PCDs were estimated. Adjusted logistic regression models were used to evaluate the association between the number of PCDs and PAS severity.</p><p><strong>Results: </strong>In our referral center, the frequency of placenta accreta was 18.1% (n = 32/176), placenta increta 55.6% (n = 98/176), and placenta percreta 26.1% (n = 46/176). There were 8 patients with no PCDs, 48 with 1 PCD, 62 with 2 PCDs, and 58 with ≥3 PCDs. The frequency of placenta increta was similar among all PCDs groups; however, the frequency of placenta percreta was significantly higher among women with ≥3 PCDs (25/58 [43.1%]) as compared to those with ≤2 PCDs (21/118 [17.7%], aOR, 3.49 [95% confidence interval, 1.73-7.05]; p = 0.005). Patients with no PCDs had a higher frequency of placenta accreta and a similar frequency of placenta increta to those with a history of PCDs.</p><p><strong>Limitations: </strong>The study was conducted at a single center with a high referral rate for severe forms of PAS, which may restrict the generalizability of the findings. Additionally, the classification of PAS relies heavily on histopathologic interpretation, which can introduce potential biases depending on provider experience and the criteria used.</p><p><strong>Conclusion: </strong>The frequency placenta increta was similar among women with the suspicion of PAS regardless of the number of PCDs. 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The Number of Previous Cesarean Deliveries and Severity of Placenta Accreta Spectrum: A Referral Center Experience.
Objective: The objective of this study was to evaluate the frequency of severe stages of placenta accreta spectrum (PAS) in relation to the number of previous cesarean deliveries (PCDs).
Design: We conducted a retrospective cohort study.
Setting: The study was carried out at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
Participants: A total of 176 patients with histopathologically confirmed PAS were included in the study. The frequency of each stage of PAS severity was analyzed in relation to the number of PCDs Methods: Differences in the frequency of different stages of PAS severity among patients with varying numbers of PCDs were estimated. Adjusted logistic regression models were used to evaluate the association between the number of PCDs and PAS severity.
Results: In our referral center, the frequency of placenta accreta was 18.1% (n = 32/176), placenta increta 55.6% (n = 98/176), and placenta percreta 26.1% (n = 46/176). There were 8 patients with no PCDs, 48 with 1 PCD, 62 with 2 PCDs, and 58 with ≥3 PCDs. The frequency of placenta increta was similar among all PCDs groups; however, the frequency of placenta percreta was significantly higher among women with ≥3 PCDs (25/58 [43.1%]) as compared to those with ≤2 PCDs (21/118 [17.7%], aOR, 3.49 [95% confidence interval, 1.73-7.05]; p = 0.005). Patients with no PCDs had a higher frequency of placenta accreta and a similar frequency of placenta increta to those with a history of PCDs.
Limitations: The study was conducted at a single center with a high referral rate for severe forms of PAS, which may restrict the generalizability of the findings. Additionally, the classification of PAS relies heavily on histopathologic interpretation, which can introduce potential biases depending on provider experience and the criteria used.
Conclusion: The frequency placenta increta was similar among women with the suspicion of PAS regardless of the number of PCDs. Women with ≥3 PCDs had a significantly higher frequency of placenta percreta.
期刊介绍：
This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.
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