Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: A case-control study

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Author(s)
Farquhar, Cynthia M
Li, Zhuoyang
Lensen, Sarah
McLintock, Claire
Pollock, Wendy
Peek, Michael J
Ellwood, David
Knight, Marian
Homer, Caroline SE
Vaughan, Geraldine
Wang, Alex
Sullivan, Elizabeth
Griffith University Author(s)
Year published
2017
Metadata
Show full item recordAbstract
Objective: Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.
Design: Case–control study.
Setting: Sites in Australia and New Zealand with at least 50 births per year.
Participants: Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases
were included and 570 controls.
Methods: Data were collected using the Australasian Maternity Outcomes Surveillance System.
Primary ...
View more >Objective: Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes. Design: Case–control study. Setting: Sites in Australia and New Zealand with at least 50 births per year. Participants: Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls. Methods: Data were collected using the Australasian Maternity Outcomes Surveillance System. Primary and secondary outcome measures: Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death). Results: The incidence of placenta accreta was 44.2/100 000 women giving birth (95%CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40vs <30: 19.1, 95%CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95%CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2prior sections vs 0: 13.8, 95%CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95%CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%). Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95%CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95%CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95%CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
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View more >Objective: Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes. Design: Case–control study. Setting: Sites in Australia and New Zealand with at least 50 births per year. Participants: Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls. Methods: Data were collected using the Australasian Maternity Outcomes Surveillance System. Primary and secondary outcome measures: Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death). Results: The incidence of placenta accreta was 44.2/100 000 women giving birth (95%CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40vs <30: 19.1, 95%CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95%CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2prior sections vs 0: 13.8, 95%CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95%CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%). Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95%CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95%CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95%CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
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Journal Title
BMJ Open
Volume
7
Issue
10
Copyright Statement
© 2017. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Subject
Public Health and Health Services not elsewhere classified
Clinical Sciences
Public Health and Health Services
Other Medical and Health Sciences