Risk Factors for Placenta Accreta: A Large Prospective Cohort
13 August 2013
11 October 2013
12 December 2013 (eFirst)
Objective Placenta previa and prior cesarean delivery are known risk factors for placenta accreta. However, other risk factors have not been identified. Our objective was to examine risk factors for accreta using data collected prospectively in a large multicenter cohort.
Study Design Secondary analysis of women with accreta compared to those without accreta in a large multicenter cesarean delivery cohort. Potential accreta risk factors were examined by univariate and multivariate analyses.
Results In this study, 196 of 73,257 (0.27%) cesarean deliveries were complicated by accreta. As expected, women with increasing numbers of prior cesareans were more likely to have an accreta (p < 0.001), as were women with previa (adjusted odds ratio [OR], 34.9; 95% confidence interval [CI], 22.4–54.3). We also considered only patients with previa and examined the following variables: maternal demographics, prior cesareans, interval between deliveries, parity, body mass index, tobacco use, and coexisting hypertension or diabetes. In this model, patients with previa and two or three prior cesarean deliveries had an adjusted OR for accreta of 4.9 (95% CI, 1.7–14.3) or 7.7 (95% CI, 2.4–24.9), respectively. However, no other variables were significantly associated with accreta.
Conclusion Patients with previa have increased risk for accreta that increases with the number of prior cesarean deliveries. However, no other maternal characteristics were associated with accreta.
The title “Risk factors for the development of placenta accreta” was presented at The Society for Gynecologic Investigation 60th Annual Meeting in Orlando, FL, March 23, 2013 (Abstract #S-189).
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