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Am J Perinatol 2019; 36(05): 472-475
DOI: 10.1055/s-0038-1669440
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Occult Placenta Accreta: Risk Factors, Adverse Obstetrical Outcomes, and Recurrence in Subsequent Pregnancies

Clodagh Mullen
1   Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, MacDonald Women's Hospital, Cleveland, Ohio
,
Ashley N. Battarbee
2   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
Linda M. Ernst
3   Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois
,
Alan M. Peaceman
4   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

19 November 2017

11 July 2018

Publication Date:
05 September 2018 (online)

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Abstract

Objective To assess the risk factors, adverse obstetrical outcomes, and recurrence risk associated with pathologically diagnosed occult placenta accreta.

Study Design This was a retrospective observational study of clinically adherent placentas requiring manual extraction that underwent pathological examination. Cases were defined as those with histological evidence of placenta accreta, and controls were defined as those without accreta. All subsequent pregnancies were evaluated to determine the recurrence risk of occult accreta in future pregnancies.

Results Of 491 women with clinically adherent placentas, 100 (20.1%) with a pathological diagnosis of occult accreta were compared with 391 (79.9%) without occult accreta. In bivariable analysis, risk factors associated with occult accreta included a history of previous cesarean (19 vs. 10.7%; p = 0.03) and prior uterine surgery (35 vs. 19.7%; p = 0.001). Adverse obstetrical outcomes were more common in women with occult accreta including postpartum hemorrhage (59 vs. 31.7%; p < 0.001) and peripartum hysterectomy (21 vs. 0.3%; p < 0.001). In 130 subsequent pregnancies, there was an increased risk of retained placenta (42.9 vs. 19%; p = 0.04) and recurrence of occult accreta (29.6 vs. 6.8%; p = 0.05).

Conclusion Occult accreta is associated with an increased risk of hemorrhagic morbidity and recurrence of morbidly adherent placenta in subsequent pregnancies.

Keywords

retained placenta - focal accreta - postpartum hemorrhage - placental pathology - occult accretas - histological accreta

Condensation

Occult placenta accreta is associated with significant hemorrhagic morbidity and recurrence in future pregnancies.


Note

This paper was presented in a poster format at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists, San Diego, CA, May 6 to 9, 2017.


 

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