Incidence and Risk Factors for Placenta Accreta/Increta/Percreta in the UK: A National Case-Control Study

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Incidence and Risk Factors for Placenta Accreta/Increta/Percreta in the UK: A National Case-Control Study

Authors
Publisher
Public Library of Science
Volume
7
Issue
12
Identifiers
DOI: 10.1371/journal.pone.0052893
Keywords
  • Biology
  • Medicine
  • Epidemiology
  • Pregnancy
  • Women'S Health
  • Research Article
  • Case-Control Studies
  • Pregnancy Complications
  • Obstetrics And Gynecology
  • Population Biology
  • Clinical Research Design
  • Observational Studies
  • Management Of High-Risk Pregnancies

Abstract

Background Placenta 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. Methods A 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. Results The 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). Conclusions Women 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.

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