title: A prior placenta accreta is an independent risk factor for post-partum hemorrhage in subsequent gestations.
abstract: OBJECTIVE
  The rate of placenta accreta, a life threatening condition, is constantly increasing, mainly due to the rise in the rates of cesarean sections. This study is aimed to determine the effect of a history of placenta accreta on subsequent pregnancies.
  
  
  METHODS
  A population based retrospective cohort study was designed, including all women who delivered at our medical center during the study period. The study population was divided into two groups including pregnancies with: (1) a history of placenta accreta (n=514); and (2) control group without placenta accreta (n=239,126).
  
  
  RESULTS
  (1) A history of placenta accreta is an independent risk factor for postpartum hemorrhage (adjusted OR 4.1, 95% CI 1.5-11.5) as were placenta accreta (adjusted OR 22.0, 95% CI 14.0-36.0) and placenta previa (adjusted OR 7.6, 95% CI 4.4-13.2) in the current pregnancy, and a prior cesarean section (adjusted OR 1.7, 95% CI 1.3-2.2); (2) in addition, placenta accreta in a previous pregnancy is associated with a reduced rate of mild preeclampsia in future pregnancies (1.8% vs. 3.4%, RR 0.51, 95% CI 0.26-0.98); (3) however, in spite of the higher rate of neonatal deaths in the study group, a history of placenta accreta was not an independent risk factor for total perinatal mortality (adjusted OR 1.0, 95% CI 0.5-1.9) after adjusting for confounders.
  
  
  CONCLUSIONS
  A history of placenta accreta is an independent risk factor for postpartum hemorrhage. This should be taken into account in order to ensure a safety pregnancy and delivery of these patients.
authors: School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Adi
authors: A
authors: Vinograd
authors: Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Tamar
authors: T
authors: Wainstock
authors: Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Moshe
authors: M
authors: Mazor
authors: Department of Obstetrics and Gynecology, Azienda Ospedaliera-Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
authors: Salvatore Andrea
authors: SA
authors: Mastrolia
authors: Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Ruthy
authors: R
authors: Beer-Weisel
authors: Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Vered
authors: V
authors: Klaitman
authors: Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Doron
authors: D
authors: Dukler
authors: Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Batel
authors: B
authors: Hamou
authors: Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Neta
authors: N
authors: Benshalom-Tirosh
authors: School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Ofir
authors: O
authors: Vinograd
authors: Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel. Electronic address: erezof@bgu.ac.il.
authors: Offer
authors: O
authors: Erez
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D016017:Odds Ratio; D054238:Perinatal Mortality; D010921:Placenta Accreta / Q000453:epidemiology* / Q000503:physiopathology; D010923:Placenta Previa / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Blood transfusion; GEE model; Maternal complication; Neonatal mortality; Placenta previa; Previous cesarean section