Impact of Labor in Primary Cesarean Delivery on Subsequent Risk of Placenta Accreta

Lior Kashani Ligumsky; Miriam Lopian; Anhyo Jeong; Angela Desmond; Avshalom Elmalech; Ariel Many; Guadalupe Martinez; Deborah Krakow; Yalda Afshar

doi:10.1055/a-2693-8599

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol
DOI: 10.1055/a-2693-8599

Original Article

Impact of Labor in Primary Cesarean Delivery on Subsequent Risk of Placenta Accreta

Authors

Lior Kashani Ligumsky

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, United States

²Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel

³Department of Obstetrics and Gynecology, Edith Wofson Medical Center, Holon, Israel
Miriam Lopian

²Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
Anhyo Jeong

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, United States
Angela Desmond

⁴Division of Neonatology, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, California, United States
Avshalom Elmalech

⁵Department of Information Science, Bar-Ilan University, Ramat Gan, Israel
Ariel Many

²Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
Guadalupe Martinez

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, United States
Deborah Krakow

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, United States

⁶Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States

⁷Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, United States
Yalda Afshar

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, United States

⁸Molecular Biology Institute, University of California, Los Angeles, California, United States

Abstract

Objective

This study aimed to evaluate whether a primary cesarean delivery (CD) performed during labor increases the risk of placenta accreta spectrum (PAS) disorders in a high-parity population with a low overall CD rate.

Study Design

This retrospective cohort study included singleton pregnancies with a confirmed International Federation of Gynecology and Obstetrics (FIGO) PAS diagnosis at a single tertiary center (2011–2022). Each PAS case was matched 1:1 to a control without PAS based on parity, number of previous CDs, and history of vaginal birth after cesarean. Multivariable logistic regression assessed the association between labored versus unlabored primary CD and PAS, adjusting for placenta previa, in vitro fertilization, prior postpartum hemorrhage, and prior dilation and curettage.

Results

Among 128,485 deliveries, 45 PAS cases (0.04%) were identified and matched to 45 controls. Median parity was 5.0; 34% had three or more prior CDs. Labored primary CD was associated with increased PAS risk (adjusted odds ratio: 6.3, 95% confidence interval [CI]: 1.7–23.3; p < 0.05). Placenta previa and prior postpartum hemorrhage were also independently associated with PAS. No significant differences in maternal or neonatal outcomes were observed between the labored and elective primary cesarean groups.

Conclusion

Primary CD during labor increases PAS risk six-fold in subsequent pregnancies, warranting consideration in counseling and surgical decision-making.

Key Points

A labored CD raises the risk of PAS in the next pregnancy by sixfold.
No significant differences in maternal or neonatal outcomes in subsequent pregnancy between labored and unlabored cesarean sections.
The study highlights the importance of recognizing labored cesarean section as a PAS risk factor in future pregnancies.

Keywords

placenta accreta spectrum - labored cesarean delivery - elective cesarean delivery - risk factors

Volltext

Referenzen

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