Basal Plate Myofibers and the Risk of Placenta Accreta Spectrum in the Subsequent Pregnancy: A Large Single-Center Cohort

Abstract

Objective We aimed to evaluate whether there is a significant association between a placental pathology diagnosis basal plate myofibers (BPMF) in an index pregnancy with placenta accreta spectrum (PAS) in the subsequent pregnancy.

Study Design We conducted a retrospective nested cohort study of all cases with a histopathological finding of BPMF between August 2012 and March 2020 at a single tertiary referral center. Data were collected for all subjects (cases and controls) with at least two consecutive pregnancies (the initial index pregnancy and at least one subsequent pregnancy) accompanied by a concomitant record of histopathological study of the placenta at our center. The primary outcome was pathologically confirmed PAS in the subsequent pregnancy. Data are presented as percentage or median, interquartile range accordingly.

Results A total of n = 1,344 participants were included, of which n = 119 (index cases) carried a contemporaneous histopathological diagnosis of BPMF during the index pregnancy and n = 1,225 did not (index controls). Among the index cases, patients with BPMF were older (31.0 [20, 42] vs. 29.0 [15, 43], p < 0.001), more likely to have undergone in vitro fertilization (IVF) for conception (10.9 vs. 3.8%, p = 0.001) and were of a more advanced gestational age at delivery (39.0 [25, 41] vs. 38.0 [20, 42], p = 0.006). In the subsequent pregnancy, the rate of PAS was significantly higher among the BPMF index cases (6.7 vs. 1.1%, p < 0.001). After adjusting for maternal age and IVF, a histopathological diagnosis of BPMF in an index pregnancy was shown to be a significant risk factor for PAS in the subsequent gestation (hazard ratio: 5.67 [95% confidence interval: 2.28, 14.06], p < 0.001).

Conclusion Our findings support that a histopathological diagnosis of BPMF is an independent risk factor for PAS in the subsequent pregnancy.

Key Points

• BPMF may indicate morbid adherence of placenta.

• Patients with BPMF were older and more likely to have undergone IVF for conception.

• The BPMF in the current pregnancy is an independent risk factor for PAS in the subsequent pregnancy.

Keywords

placenta accreta - basal plate myofibers - morbid adherent - microscopic placenta accreta

Authors' Contributions

Amir A.S., J.E., K.M.A., and H.E. designed the study. K.H., B.S., R.K., J.L.H., and S.G. conducted the interpretation and analysis of the data, with feedback from the other authors. K.H., J.N.J., E.D., Alireza A.S., and K.A.F. drafted the article, with supervision, and M.G., S.A.S., M.E.F., M.D.B., A.M., and A.A.N. provided critical revision of the article. E.C.C. and J.L.H. did the histopathological assessment and contributed to critical appraisal of findings. All authors approved the final version for publication.

Publication History

Received: 15 February 2023

Accepted: 08 June 2023

Accepted Manuscript online:
13 June 2023

Article published online:
20 July 2023

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