A PEER-REVIEWED JOURNAL OF RESEARCH AND CLINICAL MEDICINEISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Risk Factors for Placenta Increta in Women with a Uterine Cesarean Section Scar

DOI:10.31550/1727-2378-2019-159-4-14-18
For citation: Igitova M.B., Borovkov V.A., Ershova E.G., Pachkovskaya O.Yu., Cherkasova T.M., Goltsova N.P. Risk Factors for Placenta Increta in Women with a Uterine Cesarean Section Scar. Doctor.Ru. 2019; 4(159): 14–18. DOI: 10.31550/1727-2378-2019-159-4-14-18

Study Objective: To identify risk factors for placenta increta in women with a uterine cesarean section scar.

Study Design: This was a retrospective analysis with a case-control study.

Materials and Methods: The course and outcomes of pregnancies were analyzed in 75 women with a uterine scar and placenta increta, and 150 pregnant women with a uterine scar who did not have placenta increta (control group).

Study Results: The following risk factors for placenta increta were identified: age above 30 (relative risk [RR] = 1.51; 95% confidence interval (CI): 1.04-2.17; p=0.027), history of two or more cesarean sections (RR=2.26; 95% CI: 1.58-3.22; p=0.0001), postoperative complications (odds ratio [OR] = 12.7; 95% CI: 2.74-50.0; p=0.0012), fourth or subsequent pregnancy (RR=2.49; 95% CI: 1.67-3.69; p=0.0001), history of three or more spontaneous or induced abortions (RR=1.98; 95% CI: 1.36-2.88; p=0.0003), interpregnancy interval of less than two years (RR=1.55; 95% CI: 1.04-2.31; p=0.0303), signs of undifferentiated connective tissue dysplasia (RR=1.69; 95% CI: 1.17-2.43; p=0.0046), history of chronic genital infections and inflammation (RR=2.11; 95% CI: 1.49-2.99; p < 0.0001), and smoking (OR=1.76; 95% CI: 1.13-2.76; p=0.013).

Patients with placenta previa or placenta located primarily on the anterior uterine wall in the scar area, as detected by ultrasound at the end of the first trimester, were several times more likely to have placenta increta (RR=41.7%; 95% CI: 10.5-1652.8; p < 0.0001).

These data were the basis for developing a rating scale for risk of placenta increta. The clinical value of comprehensive risk assessment for this complication is characterized by 85.3% sensitivity and 90.0% specificity, which are acceptable levels for its use in practice.

Conclusion: Risk factors for placenta increta can be reliably assessed and a group of candidates for more thorough monitoring identified during early pregnancy by evaluating the clinical and medical-history data of pregnant women and the results of their biochemical and ultrasound screening tests.

The authors declare that they do not have any conflict of interests.

M.B. Igitova — Altai State Medical University, Russian Ministry of Health; 40 Lenin Prospect, Barnaul, Russian Federation 656038. Е-mail: Igitova-2011@mail.ru

V.A. Borovkov — Altai Region Perinatal (Clinical) Center; 29 Popov St, Barnaul, Russian Federation 656019. E-mail: na4med_kpc@mail.ru

E.G. Ershova — Altai Region Perinatal (Clinical) Center; 29 Popov St, Barnaul, Russian Federation 656019. E-mail: guzkpc2010@mail.ru

O.Yu. Pachkovskaya — Altai State Medical University, Russian Ministry of Health; 40 Lenin Prospect, Barnaul, Russian Federation 656038. E-mail: pipulj@mail.ru

T.M. Cherkasova — Altai State Medical University, Russian Ministry of Health; 40 Lenin Prospect, Barnaul, Russian Federation 656038. E-mail: na4med_kpc@mail.ru

N.P. Goltsova — Altai Region Perinatal (Clinical) Center; 29 Popov St, Barnaul, Russian Federation 656019. E-mail: argorod3541@rambler.ru

Доктор.ру
LITERATURE
  1. Поликарпов А.В., Александрова Г.А., Голубев Н.А., Тюрина Е.М. и др. Основные показатели здоровья матери и ребенка, деятельность службы охраны детства и родовспоможения в Российской Федерации. Министерство здравоохранения Российской Федерации. Департамент мониторинга, анализа и стратегического развития здравоохранения. ФГБУ «Центральный научно-исследовательский институт организации и информатизации здравоохранения» Минздрава Российской Федерации, 2018. [Polikarpov A.V., Aleksandrova G.A., Golubev N.A., Tyurina E.M. i dr. Osnovnye pokazateli zdorov'ya materi i rebenka, deyatel'nost' sluzhby okhrany detstva i rodovspomozheniya v Rossiiskoi Federatsii. Ministerstvo zdravookhraneniya Rossiiskoi Federatsii. Departament monitoringa, analiza i strategicheskogo razvitiya zdravookhraneniya. FGBU "Tsentral'nyi nauchno-issledovatel'skii institut organizatsii i informatizatsii zdravookhraneniya" Minzdrava Rossiiskoi Federatsii, 2018. (in Russian)]
  2. Состояние здоровья населения и деятельность здравоохранения Алтайского края в 2017 году: статистический сборник в 2 частях. Часть II (таблицы). Краевое государственное бюджетное учреждение здравоохранения «Медицинский центр — управляющая компания Алтайского медицинского кластера». Барнаул; 2018. 438 с. [Sostoyanie zdorov'ya naseleniya i deyatel'nost' zdravookhraneniya Altaiskogo kraya v 2017 godu: statisticheskii sbornik v 2 chastyakh. Chast' II (tablitsy). Kraevoe gosudarstvennoe byudzhetnoe uchrezhdenie zdravookhraneniya “Meditsinskii tsentr — upravlyayushchaya kompaniya Altaiskogo meditsinskogo klastera”. Barnaul; 2018. 438 s. (in Russian)]
  3. Асеева Е.В. Прогнозирование острой массивной кровопотери в послеродовом периоде: Автореф. дис. ... канд. мед. наук. Волгоград; 2017. 24 с. [Aseeva E.V. Prognozirovanie ostroi massivnoi krovopoteri v poslerodovom periode: avtref. dis. ... kand. med. nauk. Volgograd; 2017. 24 s. (in Russian)]
  4. Курцер М.А., Кутакова Ю.Ю., Бреслав И.Ю., Сонголова Е.Н. Рlacenta accreta: сохраняем матку. Опыт органосохраняющих операций при врастании плаценты. Status Praesens. 2013; 3(14): 14–19. [Kurtser M.A., Kutakova Yu.Yu., Breslav I.Yu., Songolova E.N. Placenta accreta: sokhranyaem matku. Opyt organosokhranyayushchikh operatsii pri vrastanii platsenty. Status Praesens. 2013; 3(14): 14–19. (in Russian)]
  5. Creanga A.A., Bateman B.T., Butwick A.J., Raleigh L., Maeda A., Kukllna E. et al. Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor? Am. J. Obstet. Gynecol. 2015; 213(3): 384.el–11. DOI: 10.1016/j.ajog.2015.05.002
  6. Смольнова Т.Ю., Буянова С.Н., Савельев С.В., Титченко Л.И., Гришин В.Л., Яковлева Н.И. Фенотипический симптомокомплекс дисплазии соединительной ткани у женщин. Клин. медицина. 2003; 8: 42–8. [Smol'nova T.Yu., Buyanova S.N., Savel'ev S.V., Titchenko L.I., Grishin V.L., Yakovleva N.I. Fenotipicheskii simptomokompleks displazii soedinitel'noi tkani u zhenshchin. Klin. meditsina. 2003; 8: 42–8. (in Russian)]
  7. Кан Н.Е., Амирасланов Э.Ю., Тютюнник В.Л. Балльная шкала недифференцированной дисплазии соединительной ткани в прогнозировании акушерских осложнений. Акушерство и гинекология. 2014; 7: 7–9. [Kan N.E., Amiraslanov Je.Ju., Tjutjunnik V.L. Ball'naja shkala nedifferincirovannoj displazii soedinitel'noj tkani v prognozirovanii akusherskih oslozhnenij. Akusherstvo i ginekologija. 2014; 7: 7–9. (in Russian)]
  8. Латышкевич О.А. Врастание плаценты у пациенток с рубцом на матке после кесарева сечения. Органосохраняющие операции: Автореф. дис. ... канд. мед. наук. М;, 2015. 24 с. [Latyshkevich O.A. Vrastanie platsenty u patsientok s rubtsom na matke posle kesareva secheniya. Organosokhranyayushchie operatsii: Avtoref. dis. ... kand. med. nauk. M.; 2015. 24 s. (in Russian)]

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