Related Factors of Placenta Accreta Spectrum in Women with Repeat Caesarean Deliveries and Its Effect on Pregnancy Outcomes
Placenta Accreta Spectrum (PAS) is an abnormal attachment of trophoblastic tissues to the uterine myometrium. It is a dangerous pregnancy complication and one of the leading causes of maternal morbidity and mortality. PAS may induce serious complications such as postpartum haemorrhage (PPH) and hysterectomy. Prior caesarean delivery and placenta previa are the major risk factors of PAS. The rate of caesarean delivery (CD) without medical indication has been raised in recent years. In the current study, we evaluated 142 women with a history of prior CD and divided them into two groups. Eighty-five patients had prior CD and PAS in their current pregnancy (case group) and fifty-seven patients had prior CD without PAS (control group). Demographic data and past gynaecological history, such as placenta previa, were collected. We found the prior CD and placenta previa increase the risk of PAS significantly. PAS was associated with more emergent caesarean deliveries and hysterectomies. We didn`t find a significant association between prior hysteroscopies and curettages with increased risk of PAS.
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This cross-sectional study is approved by the research ethics committees of the Qom University of Medical Science. A total number of 142 patients with a history of prior caesarean delivery (CD), referred to teaching hospitals of Qom city between 21st march 2019 and 21st march 2021, were included in the study. Inclusion criteria were women aged 18-50 with at least one history of caesarean section and no prior uterine manipulation and surgery. Patients who had a normal vaginal delivery and incomplete questionnaire were excluded from the analysis. A researcher-made questionnaire was designed. Personal consent was obtained from each participant. Each query form contained numbers of past CDs, past obstetrics history, past surgical history and curettages, history of ectopic pregnancy, infertility, infectious diseases, financial status, and demographic information such as maternal age, etc. Patients were asked to fill out a query form during their admission to the general ward after surgery. Researchers examined each query form after completion and confirmed it if answered correctly. Statistical analysis performed by IBM® SPSS® for Windows® version 20 [IBM Corp., Armonk, NY, USA]. Frequency, percentages, rates, mean, and standard deviation were used in both patients with and without PAS. In order to find out related factors that were associated with increased risk of PAS, regression models were estimated. Non-parametric tests were used for variables that were not normally distributed when needed. To compare categorical variables Pearson’s chi-square test was used. Continuous variables were evaluated with an Independent T-test and ANOVA, A p-value less than 0.05 was considered statistically significant.