Occult Placenta Accreta

Risk Factors, Adverse Obstetrical Outcomes, and Recurrence in Subsequent Pregnancies

Clodagh Mullen*, Ashley N. Battarbee, Linda M. Ernst, Alan M Peaceman

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objective To assess the risk factors, adverse obstetrical outcomes, and recurrence risk associated with pathologically diagnosed occult placenta accreta. Study Design This was a retrospective observational study of clinically adherent placentas requiring manual extraction that underwent pathological examination. Cases were defined as those with histological evidence of placenta accreta, and controls were defined as those without accreta. All subsequent pregnancies were evaluated to determine the recurrence risk of occult accreta in future pregnancies. Results Of 491 women with clinically adherent placentas, 100 (20.1%) with a pathological diagnosis of occult accreta were compared with 391 (79.9%) without occult accreta. In bivariable analysis, risk factors associated with occult accreta included a history of previous cesarean (19 vs. 10.7%; p = 0.03) and prior uterine surgery (35 vs. 19.7%; p = 0.001). Adverse obstetrical outcomes were more common in women with occult accreta including postpartum hemorrhage (59 vs. 31.7%; p < 0.001) and peripartum hysterectomy (21 vs. 0.3%; p < 0.001). In 130 subsequent pregnancies, there was an increased risk of retained placenta (42.9 vs. 19%; p = 0.04) and recurrence of occult accreta (29.6 vs. 6.8%; p = 0.05). Conclusion Occult accreta is associated with an increased risk of hemorrhagic morbidity and recurrence of morbidly adherent placenta in subsequent pregnancies.

Original languageEnglish (US)
Pages (from-to)472-475
Number of pages4
JournalAmerican journal of perinatology
Volume36
Issue number5
DOIs
StatePublished - Jan 1 2019

Fingerprint

Placenta Accreta
Placenta
Recurrence
Pregnancy
Retained Placenta
Peripartum Period
Postpartum Hemorrhage
Hysterectomy
Observational Studies
Retrospective Studies
Morbidity

Keywords

  • focal accreta
  • histological accreta
  • occult accretas
  • placental pathology
  • postpartum hemorrhage
  • retained placenta

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

@article{d165ad568cbd4d8299a3a2efc273862a,
title = "Occult Placenta Accreta: Risk Factors, Adverse Obstetrical Outcomes, and Recurrence in Subsequent Pregnancies",
abstract = "Objective To assess the risk factors, adverse obstetrical outcomes, and recurrence risk associated with pathologically diagnosed occult placenta accreta. Study Design This was a retrospective observational study of clinically adherent placentas requiring manual extraction that underwent pathological examination. Cases were defined as those with histological evidence of placenta accreta, and controls were defined as those without accreta. All subsequent pregnancies were evaluated to determine the recurrence risk of occult accreta in future pregnancies. Results Of 491 women with clinically adherent placentas, 100 (20.1{\%}) with a pathological diagnosis of occult accreta were compared with 391 (79.9{\%}) without occult accreta. In bivariable analysis, risk factors associated with occult accreta included a history of previous cesarean (19 vs. 10.7{\%}; p = 0.03) and prior uterine surgery (35 vs. 19.7{\%}; p = 0.001). Adverse obstetrical outcomes were more common in women with occult accreta including postpartum hemorrhage (59 vs. 31.7{\%}; p < 0.001) and peripartum hysterectomy (21 vs. 0.3{\%}; p < 0.001). In 130 subsequent pregnancies, there was an increased risk of retained placenta (42.9 vs. 19{\%}; p = 0.04) and recurrence of occult accreta (29.6 vs. 6.8{\%}; p = 0.05). Conclusion Occult accreta is associated with an increased risk of hemorrhagic morbidity and recurrence of morbidly adherent placenta in subsequent pregnancies.",
keywords = "focal accreta, histological accreta, occult accretas, placental pathology, postpartum hemorrhage, retained placenta",
author = "Clodagh Mullen and Battarbee, {Ashley N.} and Ernst, {Linda M.} and Peaceman, {Alan M}",
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Occult Placenta Accreta : Risk Factors, Adverse Obstetrical Outcomes, and Recurrence in Subsequent Pregnancies. / Mullen, Clodagh; Battarbee, Ashley N.; Ernst, Linda M.; Peaceman, Alan M.

In: American journal of perinatology, Vol. 36, No. 5, 01.01.2019, p. 472-475.

Research output: Contribution to journalArticle

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T1 - Occult Placenta Accreta

T2 - Risk Factors, Adverse Obstetrical Outcomes, and Recurrence in Subsequent Pregnancies

AU - Mullen, Clodagh

AU - Battarbee, Ashley N.

AU - Ernst, Linda M.

AU - Peaceman, Alan M

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective To assess the risk factors, adverse obstetrical outcomes, and recurrence risk associated with pathologically diagnosed occult placenta accreta. Study Design This was a retrospective observational study of clinically adherent placentas requiring manual extraction that underwent pathological examination. Cases were defined as those with histological evidence of placenta accreta, and controls were defined as those without accreta. All subsequent pregnancies were evaluated to determine the recurrence risk of occult accreta in future pregnancies. Results Of 491 women with clinically adherent placentas, 100 (20.1%) with a pathological diagnosis of occult accreta were compared with 391 (79.9%) without occult accreta. In bivariable analysis, risk factors associated with occult accreta included a history of previous cesarean (19 vs. 10.7%; p = 0.03) and prior uterine surgery (35 vs. 19.7%; p = 0.001). Adverse obstetrical outcomes were more common in women with occult accreta including postpartum hemorrhage (59 vs. 31.7%; p < 0.001) and peripartum hysterectomy (21 vs. 0.3%; p < 0.001). In 130 subsequent pregnancies, there was an increased risk of retained placenta (42.9 vs. 19%; p = 0.04) and recurrence of occult accreta (29.6 vs. 6.8%; p = 0.05). Conclusion Occult accreta is associated with an increased risk of hemorrhagic morbidity and recurrence of morbidly adherent placenta in subsequent pregnancies.

AB - Objective To assess the risk factors, adverse obstetrical outcomes, and recurrence risk associated with pathologically diagnosed occult placenta accreta. Study Design This was a retrospective observational study of clinically adherent placentas requiring manual extraction that underwent pathological examination. Cases were defined as those with histological evidence of placenta accreta, and controls were defined as those without accreta. All subsequent pregnancies were evaluated to determine the recurrence risk of occult accreta in future pregnancies. Results Of 491 women with clinically adherent placentas, 100 (20.1%) with a pathological diagnosis of occult accreta were compared with 391 (79.9%) without occult accreta. In bivariable analysis, risk factors associated with occult accreta included a history of previous cesarean (19 vs. 10.7%; p = 0.03) and prior uterine surgery (35 vs. 19.7%; p = 0.001). Adverse obstetrical outcomes were more common in women with occult accreta including postpartum hemorrhage (59 vs. 31.7%; p < 0.001) and peripartum hysterectomy (21 vs. 0.3%; p < 0.001). In 130 subsequent pregnancies, there was an increased risk of retained placenta (42.9 vs. 19%; p = 0.04) and recurrence of occult accreta (29.6 vs. 6.8%; p = 0.05). Conclusion Occult accreta is associated with an increased risk of hemorrhagic morbidity and recurrence of morbidly adherent placenta in subsequent pregnancies.

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KW - histological accreta

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KW - placental pathology

KW - postpartum hemorrhage

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