High Risk Factors for Placenta Accreta Other than Pregnancy and Their Impact on Patient Prognosis

Abstract

Abstract Objective This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications. Methods This retrospective cohort study included 1009 patients diagnosed with placenta accreta spectrum disorders based on standardized diagnostic criteria across 10 tertiary hospitals in China between January 1, 2018, and December 31, 2018; 45 patients without a history of pregnancy were selected. The collected data mainly included demographic characteristics (including age, operative history, and ultrasound findings) and maternal-fetal outcomes (including any history of intraoperative bleeding, blood transfusion details, maternal-fetal complications, and fetal Apgar scores). SPSS 24.0 was used for statistical analyses. The Mann-Whitney U test and logistic regression were performed; a two-tailed P < 0.050 was considered statistically significant. Results Ultrasound-based detection of placenta previa (χ 2 = 9.911, P = 0.003) showed a strong association with placenta accreta spectrum types. The severity of placenta accreta spectrum was directly proportional to the likelihood of having coexistent complete placenta previa (χ 2 = 11.626, P = 0.009) and being diagnosed by ultrasound (χ 2 = 5.449, P = 0.047). Blood transfusion also impacted placenta accreta spectrum types in relation to maternal prognosis (χ 2 = 8.785, P = 0.004). On univariate analysis, older age led to more complications (U = 82.000, P = 0.011), and in vitro fertilization-embryo transfer caused more intraoperative bleeding (U = 91.500, P = 0.007). Although the 1- and 5-minute Apgar scores were statistically significant, the rates of neonatal asphyxia did not differ (P > 0.050). Endometrial damage led to lower Apgar scores on both univariate (1 minute: U = 29.500, P = 0.027; and 5 minutes: U = 33.500, P = 0.031) and multivariate (1 minute: β = −1.510, 95% confidence interval, −2.639 to 0.381, P = 0.010; and 5 minutes: β = −0.968, 95% confidence interval, −1.779 to 0.157, P = 0.021) analyses. Conclusion In patients who had no history of pregnancy, placenta previa was a strong risk factor for severe placenta accreta spectrum disorders. Endometrial damage led to lower Apgar scores; this warrants greater consideration in the clinic.