Abstract
BackgroundPlacenta accreta/increta/percreta is associated with major pregnancy complications and is thought to be becoming more common. The aims of this study were to estimate the incidence of placenta accreta/increta/percreta in the UK and to investigate and quantify the associated risk factors.MethodsA national case-control study using the UK Obstetric Surveillance System was undertaken, including 134 women diagnosed with placenta accreta/increta/percreta between May 2010 and April 2011 and 256 control women.ResultsThe estimated incidence of placenta accreta/increta/percreta was 1.7 per 10,000 maternities overall; 577 per 10,000 in women with both a previous caesarean delivery and placenta praevia. Women who had a previous caesarean delivery (adjusted odds ratio (aOR) 14.41, 95%CI 5.63–36.85), other previous uterine surgery (aOR 3.40, 95%CI 1.30–8.91), an IVF pregnancy (aOR 32.13, 95%CI 2.03–509.23) and placenta praevia diagnosed antepartum (aOR 65.02, 95%CI 16.58–254.96) had raised odds of having placenta accreta/increta/percreta. There was also a raised odds of placenta accreta/increta/percreta associated with older maternal age in women without a previous caesarean delivery (aOR 1.30, 95%CI 1.13–1.50 for every one year increase in age).ConclusionsWomen with both a prior caesarean delivery and placenta praevia have a high incidence of placenta accreta/increta/percreta. There is a need to maintain a high index of suspicion of abnormal placental invasion in such women and preparations for delivery should be made accordingly.
Highlights
Abnormal placental adherence can be classified into three distinct conditions: placenta accreta, in which placental tissue invades the decidual surface of the myometrium; placenta increta, in which placental villi invade more deeply within the myometrium, and placenta percreta where chorionic villi penetrate through the uterine serosa and may invade surrounding organs such as the bladder
Data collection forms were received for 144 (84%) of the remaining notified cases (Figure 1) and data were obtained for 256 controls.There was a total of 134 confirmed cases of placenta accreta/increta/percreta in an estimated 798634 maternities [8,9,10], representing an estimated incidence of 1.7 per 10,000 maternities
The odds of having placenta accreta/increta/percreta rose with increasing maternal age (adjusted odds ratios (ORs) 1.15, 95% confidence intervals (CIs) 1.06 to 1.24 for every one year increase in age; presented in Table 2 as a binary variable for ease of interpretation)
Summary
Abnormal placental adherence can be classified into three distinct conditions: placenta accreta, in which placental tissue invades the decidual surface of the myometrium; placenta increta, in which placental villi invade more deeply within the myometrium, and placenta percreta where chorionic villi penetrate through the uterine serosa and may invade surrounding organs such as the bladder. The presence of placenta accreta/increta/percreta is associated with major pregnancy complications [1], and is thought to be becoming more common [2], due to a number of factors including rising maternal age at delivery and an increasing proportion of deliveries by caesarean [3,4]. The aims of this study were to estimate the national incidence of placenta accreta/increta/percreta in the UK and to investigate and quantify the associated risk factors in this population. The aims of this study were to estimate the incidence of placenta accreta/increta/percreta in the UK and to investigate and quantify the associated risk factors
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