Placenta previa-accreta: risk factors and complications.
OBJECTIVE
The purpose of this study was to identify risk factors and complications of placenta previa-accreta (PA).


METHODS
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.


CONCLUSIONS
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.
Usta
Ihab M
IM
Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
Hobeika
Elie M
EM
Musa
Antoine A Abu
AA
Gabriel
Gaby E
GE
Nassar
Anwar H
AH
D000328:Adult; D002585:Cesarean Section; D015897:Comorbidity; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000150:complications* / Q000453:epidemiology*; D010923:Placenta Previa / Q000150:complications* / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology