Placenta previa-accreta: Risk factors and complications

被引:288
作者
Usta, IM [1 ]
Hobeika, EM [1 ]
Abu Musa, AA [1 ]
Gabriel, GE [1 ]
Nassar, AH [1 ]
机构
[1] Amer Univ Beirut, Med Ctr, Dept Obstet & Gynecol, Beirut, Lebanon
关键词
placenta; previa; accreta; complications; risks;
D O I
10.1016/j.ajog.2005.06.037
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: The purpose of this study was to identify risk factors and complications of placenta previa-accreta (PA). Study design: Patients with placenta. previa (n = 347) delivered over 20 years were reviewed, divided into PA (cases, n = 22) and no accreta (controls, n = 325), and compared. Results: Cases were older with a higher incidence of smoking and previous cesarean delivery (CS). Grandmultiparity, recurrent abortions, anterior/central placentae, and low socioeconomic status were similar. PA incidence increased with the number of previous CS: 1.9%, 15.6%, 23.5%, 29.4%, 33.3%, and 50.0% after 0, 1, 2, 3, 4, and 5 previous CS, respectively. Hypertensive disorders (odds ratio [OR] 13.9, 95% CI 2.1-91.2], P =.006), smoking (OR 3.4,95% CI 1.1-10.2, P = .031) and previous CS (OR 7.9, 95% CI 1.7-37.4, P = .009) were selected by the stepwise logistic regression analysis as predictors of PA. Cases had a longer hospital stay, a higher estimated blood loss, and need for transfusion. Cesarean hysterectomy and hypogastric artery ligation were only performed in PA cases. The 2 groups had a similar delivery gestational age and neonatal outcome. Conclusion: Hypertensive disorders, smoking, and previous cesarean are risk factors for accreta in placenta previa, patients. Placenta previa-accreta is associated with higher maternal morbidity, but similar neonatal outcome compared with patients with an isolated placenta previa. (C) 2005 Mosby, Inc. All rights reserved.
引用
收藏
页码:1045 / 1049
页数:5
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