Abstract
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.
Keywords
placenta accreta spectrum disorder - prior cesarean - obstetric complications - risk
stratification
