Placenta Accreta: A Spectrum of Predictable Risk, Diagnosis, and Morbidity.
Am J Perinatol
; 36(10): 1031-1038, 2019 08.
Article
in En
| MEDLINE
| ID: mdl-30500963
ABSTRACT
OBJECTIVE:
Placenta accreta is a feared pathology, in part, because prenatal diagnosis is imperfect. It is not known whether clinical risk factors or sonographic features equally predict the entire graded pathological spectrum of placental overinvasion disease nor whether clinical outcomes differ along the spectrum. STUDYDESIGN:
We conducted a mixed methods retrospective study of a cohort of women screened sonographically for placenta accreta, cross-referenced against cases identified by pathological diagnosis (N = 416). Demographic, diagnostic, and outcome information were compared across the spectrum of invasive placentation percreta, increta, accreta, and focal accreta not requiring hysterectomy. The t-test, chi-square, Mann-Whitney, and Kruskal-Wallis tests were used for statistical analysis across groups.RESULTS:
As the depth of invasion decreased, risk factors for placental overinvasion were less common, especially placenta previa and previous cesarean. There was also reduced anticipation by sonographic examination of the placenta. Rates of adverse outcomes were lower among women with focal accreta compared with those with deeper invasion.CONCLUSION:
As the depth of invasion decreases, clinical risk factors and sonographic evaluation are less reliable in the antenatal prediction of placenta accreta. The potential for unanticipated morbidity underscores the need for improved diagnostic tools for placenta accreta spectrum.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Placenta Accreta
/
Ultrasonography, Prenatal
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Patient_preference
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
Language:
En
Journal:
Am J Perinatol
Year:
2019
Document type:
Article