Am J Perinatol
DOI: 10.1055/a-2257-3864
Short Communication

Risk Profiling In Vitro Fertilization Pregnancies that Develop Placenta Accreta Spectrum

Anna M. Modest
1   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Brett D. Einerson
2   Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
Albaro J. Nieto
3   Departamento de Ginecología y Obstetricia, Unidad de Alta Complejidad Obstétrica, Fundación Clínica Valle del Lili, Cali, Colombia
Vineet K. Shrivastava
4   Department of Obstetrics and Gynecology, Miller Children's & Women's Hospital/Long Beach, Long Beach, California
Alireza A. Shamshirsaz
5   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
6   Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
1   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
on behalf of the Pan American Society for Placenta Accreta Spectrum › Author Affiliations
Funding S.A.S. and A.M.M. received funding from the Chase Koch Foundation.


Objective The objective of this study is to assess whether, among a cohort of placenta accreta spectrum (PAS) patients, antenatal suspicion of PAS was less likely in in vitro fertilization (IVF) compared with non-IVF patients. In addition, we aimed to assess whether IVF patients exhibited similar risk factors for PAS compared with non-IVF patients.

Study Design This is an international multicenter retrospective study of patients with pathologically confirmed PAS (accreta, increta, percreta) between 1998 and 2021. PAS patients were identified through a central international PAS database. Antenatal and pathological criteria are specific to each institution. Pregnancies that resulted from IVF were compared with non-IVF pregnancies. Comparisons were made using a chi-square or Fisher's exact test for categorical variables and Wilcoxon rank-sum test for continuous variables.

Results Of the 692 pregnancies included, 44 were in the IVF group and 648 were in the non-IVF group. The IVF group was less likely to have had a prior cesarean delivery (70.5 vs. 91%, p < 0.01) but a similar prevalence of placenta previa (63.6 vs. 68.1%, p = 0.12) compared with the non-IVF group. The IVF group was also less likely to have either a prior cesarean delivery or placenta previa than the non-IVF group (79.5 vs. 95.4%, p < 0.01). Antenatal detection of PAS was less common in the IVF group compared with the non-IVF group (40.9 vs. 60.5%, p < 0.01, respectively), even when adjusted for maternal age, prior cesarean delivery, prior uterine surgery, placenta previa and site (risk ratio: 0.70, 95% confidence interval: 0.62–0.81). The IVF group had less severe pathological disease compared with the non-IVF group (p = 0.02).

Conclusion Pregnant people with PAS who underwent IVF are less likely to have an antenatal suspicion compared with non-IVF patients. This finding may be explained by the lower incidence of prior cesarean deliveries and/or placenta previa as well as less severe forms of PAS.

Key Points

  • IVF group is less likely to have antenatal PAS suspicion.

  • IVF group is less likely to have had prior cesarean delivery.

  • Risk profile for PAS differs in IVF pregnancies.

Publication History

Received: 27 June 2023

Accepted: 28 January 2024

Accepted Manuscript online:
30 January 2024

Article published online:
19 February 2024

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