Dataset Information

Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study.

ABSTRACT:

Objective

Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.

Design

Case-control study.

Setting

Sites in Australia and New Zealand with at least 50 births per year.

Participants

Cases were women giving birth (?20 weeks or fetus ?400?g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls.

Methods

Data were collected using the Australasian Maternity Outcomes Surveillance System.

Primary and secondary outcome measures

Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death).

Results

The incidence of placenta accreta was 44.2/100 000 women giving birth (95%?CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women?40?vs <30: 19.1, 95%?CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95%?CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ?2?prior sections vs 0: 13.8, 95%?CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95%?CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%).Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95%?CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95%?CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95%?CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.

SUBMITTER: Farquhar CM

PROVIDER: S-EPMC5640005 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Publications

Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study.

Farquhar Cynthia M CM Li Zhuoyang Z Lensen Sarah S McLintock Claire C Pollock Wendy W Peek Michael J MJ Ellwood David D Knight Marian M Homer Caroline Se CS Vaughan Geraldine G Wang Alex A Sullivan Elizabeth E

BMJ open 20171005 10

<h4>Objective</h4>Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.<h4>Design</h4>Case-control study.<h4>Setting</h4>Sites in Australia and New Zealand with at least 50 births per year.<h4>Participants</h4>Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a c ...[more]

PMID: 28982832

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Project description:BACKGROUND:Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt. METHODS:This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A), (n?=?38) underwent cesarean hysterectomy, group (B), (n?=?48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C), (n?=?16): the placenta was left in place. RESULTS:The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4?±?4.2?years, 60% of them had a parity ?3 and 82% of them had ?2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate. CONCLUSIONS:The incidence of PAS disorders was 0.91%. Maternal age?>?32?years, previous C.S. (? 2), multiparity (? 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling. TRIAL REGISTRATION:Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .

Project description:BackgroundUterine incarceration is a rare obstetric complication that is always associated with retroversion and prone to misdiagnosis. Pelvic examination and imaging methods including ultrasound and magnetic resonance imaging (MRI) are used as the primary diagnostic tool. We present an asymptomatic anterior uterine incarceration complicated by placenta previa and placenta accreta spectrum (PAS) disorder, which could be diagnosed during the pregnancy periods, but was first diagnosed during the cesarean section (CS) and got the surgeons into trouble.Case descriptionA 28-year-old woman, gravidity 4, parity 1, was hospitalized due to placenta previa and PAS disorder diagnosed by ultrasound and MRI at 35.6 weeks of gestation. She had not experienced any discomfort. Given her history of a previous CS, she underwent a well-prepared cesarean delivery for the termination of the pregnancy. The patient had a series of periodical ultrasound and MRI examinations in which placenta previa and placenta accreta were described in disregard of the abnormal location of cervix; consequently, interior uterine incarceration was first diagnosed during the surgery, which caused significant difficulties in the operation which lasted 3 hours and 21 minutes. The patient developed severe hemorrhaging and lost approximately 5,000 mL of blood. Fortunately, she delivered a health male infant weighing 3,440 grams with quite good Apgar scores. During the follow-up, maternal and child health was confirmed.ConclusionsWith regard to patients who have undergone previous pelvic surgery, doctors need to pay close attention to the position of the cervix, the pelvic adhesion situation during the prenatal examination, and be on alert for uterine incarceration. Uterine incarceration can be accurately recognized by periodic sonography and MRI if the radiologist is aware of this unusual condition. We do suggest that special are must be taken to avoid unnecessary trauma by misdiagnosis because of lack of awareness.

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Project description:BackgroundMaternal mortality ratio in Nigeria is one of the highest in the world. Near misses occur in larger numbers than maternal deaths hence they allow for a more comprehensive analysis of risk factors and determinants as well as outcomes of life-threatening complications in pregnancy. The study determined the incidence, characteristics, determinants and perinatal outcomes of near misses in a tertiary hospital in South-west Nigeria.MethodsA prospective case control study was conducted at the maternity units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between July 2006 and July 2007. Near miss cases were defined based on validated disease-specific criteria which included severe haemorrhage, hypertensive disorders in pregnancy, prolonged obstructed labour, infection and severe anemia. Four unmatched controls of pregnant women were selected for every near miss case. Three categories of risk factors (background, proximate, clinical) which derived from a conceptual framework were examined. The perinatal outcomes were also assessed. Bi-variate logistic regressions were used for multivariate analysis of determinants and perinatal outcomes of near miss.ResultsThe incidence of near miss was 12%. Severe haemorrhage (41.3%), hypertensive disorders in pregnancy (37.3%), prolonged obstructed labour (23%), septicaemia (18.6%) and severe anaemia (14.6%) were the direct causes of near miss. The significant risk factors with their odds ratio and 95% confidence intervals were: chronic hypertension [OR=6.85; 95% CI: (1.96 - 23.93)] having experienced a phase one delay [OR=2.07; 95% CI (1.03 - 4.17)], Emergency caesarian section [OR=3.72; 95% CI: (0.93 - 14.9)], assisted vaginal delivery [OR=2.55; 95% CI: (1.34 - 4.83)]. The protective factors included antenatal care attendance at tertiary facility [OR=0.19; 95% CI: (0.09 - 0.37)], knowledge of pregnancy complications [OR=0.47; 95% CI (0.24 - 0.94)]. Stillbirth [OR=5.4; 95% CI (2.17 - 13.4)] was the most significant adverse perinatal outcomes associated with near miss event.ConclusionsThe analysis of near misses has evolved as a useful tool in the investigation of maternal health especially in life-threatening situations. The significant risk factors identified in this study are amenable to appropriate public health and medical interventions. Adverse perinatal outcomes are clearly attributable to near miss events. Therefore the findings should contribute to Nigeria's effort to achieving MDG 4 and 5.

Dataset Information

Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study.

Objective

Design

Setting

Participants

Methods

Primary and secondary outcome measures

Results

Publications

Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study.

Similar Datasets

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