Risk Factors for Worsening Placental Invasion Within a Cohort of Placenta Accreta Spectrum Patients [ID: 1380333

Abstract

INTRODUCTION: Risk factors for placenta accreta spectrum (PAS) are overall well understood. We sought to evaluate whether those with more severe disease (increta/percreta) have a subset of patient-specific risk factors that could assist in preoperative planning. METHODS: Institutional review board-approved case–control study of patients diagnosed with PAS who underwent cesarean hysterectomy with pathology confirmed findings. Those with final pathology of placenta increta or percreta were compared to those whose final pathology demonstrated placenta accreta. Baseline characteristics and pregnancy histories were compared between groups via Student’s t tests and χ2 analysis, and a backwards logistic regression was performed to evaluate individual factors associated with more severe PAS invasion. RESULTS: A total of 83 participants met criteria with 51 (61.4%) diagnosed on pathology with increta/percreta. Those with increta/percreta had higher body mass index (34.3±7.0 versus 30.8±8.0) and higher number of prior cesarean births (2.2±1.0 versus 1.7±0.9), and were less likely to have undergone in vitro fertilization (3.9% versus 21.9%) or have a previous cesarean birth with two-layer closure compared to single-layer closure (25.0% versus 63.6%) (all P<.05). After controlling for confounders, there was a trend for more prior cesarean births to increase the risk of increta/percreta and for prior cesarean birth with two-layer closure to decrease the risk, but these were not statistically significant (adjusted odds ratio [aOR] 1.18, 95% CI 0.43–3.23, and aOR 0.51, 95% CI 0.18–1.46, respectively). CONCLUSION: Our study did not identify patient-specific factors that increased the risk for more severe PAS invasion; however, there was a trend for multiple prior cesarean births and previous cesarean birth with single-layer closure to be associated with increased risk.