Effect of Trial of Labor before Cesarean and Risk of Subsequent Placenta Accreta Spectrum Disorders
20 October 2018
28 February 2019
16 April 2019 (online)
Objective This study aimed to examine whether labor before cesarean affects the risk of placenta accreta spectrum (PAS) disorders in a subsequent pregnancy.
Study Design This is a secondary analysis of the Cesarean Registry, a prospective cohort study of women undergoing cesarean between 1999 and 2002. Women with one prior cesarean with known indications, which were categorized as likely associated with labor (labored cesarean) versus likely not associated with labor (unlabored cesarean), were included. Primary outcome was PAS disorder.
Results Of 34,224 women, 60% had a “labored cesarean” and 40% had an “unlabored cesarean.” Women with prior unlabored cesarean were more likely to have subsequent PAS disorder compared with women with a prior labored cesarean after adjusting for confounders (0.28 vs. 0.13%; adjusted odds ratio: 2.03; 95% confidence interval: 1.22–3.38).
Conclusion Prior unlabored cesarean is associated with an increased risk of PAS disorders in a subsequent pregnancy. This association may aid in risk stratification in women with suspected PAS disorders and help counsel about risks associated with cesarean on maternal request.
- 1 Committee on Obstetric Practice. Committee opinion no. 529: placenta accreta. Obstet Gynecol 2012; 120 (01) 207-211
- 2 Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005; 192 (05) 1458-1461
- 3 Martin JA, Hamilton BE, Osterman MJ. Births in the United States, 2013. NCHS Data Brief 2014; (175) 1-8
- 4 Silver RM, Fox KA, Barton JR. , et al. Center of excellence for placenta accreta. Am J Obstet Gynecol 2015; 212 (05) 561-568
- 5 Eller AG, Bennett MA, Sharshiner M. , et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117 (2 Pt 1): 331-337
- 6 Silver RM, Landon MB, Rouse DJ. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107 (06) 1226-1232
- 7 Bowman ZS, Eller AG, Bardsley TR, Greene T, Varner MW, Silver RM. Risk factors for placenta accreta: a large prospective cohort. Am J Perinatol 2014; 31 (09) 799-804
- 8 Bailit JL, Grobman WA, Rice MM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015; 125 (03) 683-689
- 9 Bakhshi T, Landon MB, Lai Y. , et al. Maternal and neonatal outcomes of repeat cesarean delivery in women with a prior classical versus low transverse uterine incision. Am J Perinatol 2010; 27 (10) 791-796
- 10 Gyamfi-Bannerman C, Gilbert S, Landon MB. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obstet Gynecol 2012; 120 (06) 1332-1337
- 11 Kamara M, Henderson JJ, Doherty DA, Dickinson JE, Pennell CE. The risk of placenta accreta following primary elective caesarean delivery: a case-control study. BJOG 2013; 120 (07) 879-886
- 12 Downes KL, Hinkle SN, Sjaarda LA, Albert PS, Grantz KL. Previous prelabor or intrapartum cesarean delivery and risk of placenta previa. Am J Obstet Gynecol 2015; 212 (05) 669.e1-669.e6
- 13 Landon MB, Hauth JC, Leveno KJ. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004; 351 (25) 2581-2589
- 14 Zeevi G, Tirosh D, Baron J, Sade MY, Segal A, Hershkovitz R. The risk of placenta accreta following primary cesarean delivery. Arch Gynecol Obstet 2018; 297 (05) 1151-1156
- 15 Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 2013; 208 (03) 219.e1-219.e7
- 16 Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One 2012; 7 (12) e52893
- 17 Jastrow N, Gauthier RJ, Gagnon G, Leroux N, Beaudoin F, Bujold E. Impact of labor at prior cesarean on lower uterine segment thickness in subsequent pregnancy. Am J Obstet Gynecol 2010; 202 (06) 563.e1-563.e7