Risk of unscheduled delivery in women with placenta accreta according to planned gestational age at delivery.

Authors

• Gabriele Saccone
• Sonia Migliorini
• Felice Crocetto
• Luigi Della Corte
• Elena Cancellieri
• Luigi Improda
• Francesco Paolo Improda
• Giuseppe Maria Maruotti
• Gennaro Cancelmo
• Ciro Imbimbo
• Giuseppe Bifulco
• Fulvio Zullo
• Vincenzo Berghella

Publication/Presentation Date

12-1-2022

Abstract

BACKGROUND: The optimal gestational age at delivery for stable women with suspected placenta accreta is still subject of debate.

OBJECTIVE: To estimate the likelihood of vaginal bleeding necessitating expedited delivery in women with placenta accreta according to gestational age at planned cesarean hysterectomy.

STUDY DESIGN: This was a multicenter cohort study. Singleton pregnancies at risk of placenta accreta because of placenta previa in the setting of prior cesarean delivery were included. Outcomes were compared in cohort of women who had planned cesarean hysterectomy at 34 0/7 - 34 6/7 weeks versus at 35 0/7 - 35 6/7 weeks. The primary outcome was incidence of vaginal bleeding severe enough to necessitate delivery.

RESULTS: 118 singleton pregnancies with placenta previa in the setting of prior cesarean delivery, and confirmed placenta accreta at the time of delivery were included in the study. Women who had planned cesarean hysterectomy at 34 weeks had lower episodes of vaginal bleeding severe enough to necessitate immediate or emergency delivery (20.6% vs 38.0%; odds ratio (OR) 0.42, 95% confidence interval (CI) 0.19 to 0.96). Eight women (11.8%) in the 34 weeks group and 6 women (12.0%) in the 35 weeks group delivered before the planned date due to onset of spontaneous labor (OR 0.98, 95% CI 0.32 to 3.02).

CONCLUSION: In singleton gestations with suspected placenta accreta, planned cesarean hysterectomy at 34 0/7 - 34 6/7 weeks was associated with a decreased chance of unscheduled delivery due to severe vaginal bleeding.

CONDENSATION: In case of placenta accreta, planned cesarean hysterectomy at 34 weeks was associated with decreased chance of unscheduled delivery due to severe vaginal bleeding.

Volume

35

Issue

25

First Page

5308

Last Page

5311

ISSN

1476-4954

Published In/Presented At

Saccone, G., Migliorini, S., Crocetto, F., Della Corte, L., Cancellieri, E., Improda, L., Improda, F. P., Maruotti, G. M., Cancelmo, G., Imbimbo, C., Bifulco, G., Zullo, F., & Berghella, V. (2022). Risk of unscheduled delivery in women with placenta accreta according to planned gestational age at delivery. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 35(25), 5308–5311. https://doi.org/10.1080/14767058.2021.1878493

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

33504230

Department(s)

Administration and Leadership

Document Type

Article