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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 

    1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, United States
    2   Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
    3   Department of Obstetrics and Gynecology, Edith Wofson Medical Center, Holon, Israel

  • Miriam Lopian 

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

  • Anhyo Jeong

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

  • Angela Desmond

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

  • Avshalom Elmalech

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

  • Ariel Many

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

  • Guadalupe Martinez

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

  • Deborah Krakow

    1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California, United States
    6   Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States
    7   Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, United States

  • Yalda Afshar 

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


Publikationsverlauf

Eingereicht: 03. Juli 2025

Angenommen: 01. September 2025

Artikel online veröffentlicht:
16. September 2025

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