Interpregnancy interval as a risk factor for placenta accreta.
OBJECTIVE
To determine if the interval from a previous delivery or cesarean to the next conception differs between patients with abnormally adherent placentas as compared to those with normally implanted placentas.


METHODS
We identified all histologically confirmed placentas--accreta, increta, and percreta--at our hospital from 1992-1999. Subjects were excluded for primigravidity in the affected pregnancy or inability to identify matched controls. Cases were matched to the next three consecutive women delivering for maternal age (> or = 35 years or < 35 years), placenta previa (yes or no), prior cesarean (yes or no), prior uterine curettage (yes or no), and prior vaginal delivery (yes or no). The primary outcomes were delivery-to-conception and cesarean-to-conception intervals. Secondary outcomes included measures of maternal and neonatal morbidity.


RESULTS
Delivery-to-conception intervals for cases and controls were 37.1 +/- 18.7 months and 37.9 +/- 22.7 months, respectively (P = .91). Cesarean-to-conception intervals for cases and controls were 35.2 +/- 18.2 and 48.1 +/- 31.0 months, respectively (P = .35). Cases were more likely to require uterine curettage (54.5 vs 0%), hysterectomy (81.8 vs 0%), and transfusion (72.7 vs 0%), all P < .001. Subjects with accreta delivered earlier (31.7 +/- 9.4 vs 38.1 +/- 2.6 weeks, P = .054) and smaller infants (2,158 +/- 1,180 g vs 3,159 +/- 781 g, P = .006) who were more likely to have five-minute Apgar scores < 7 (18.2% vs 0%, P = .038).


CONCLUSIONS
Cesarean-to-conception intervals but not delivery-to-conception intervals are shorter in patients with abnormally adherent placentas. Placenta accreta is associated with significant maternal and perinatal morbidity.
Wax
J R
JR
University of Connecticut School of Medicine, USA.
Seiler
A
A
Horowitz
S
S
Ingardia
C J
CJ
D000328:Adult; D001721:Birth Intervals; D001724:Birth Weight; D016022:Case-Control Studies; D002585:Cesarean Section; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D008423:Maternal Age; D010921:Placenta Accreta / Q000209:etiology*; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors