Outcomes of pregnancies at high risk of placenta accreta depending on the order of care during delivery
Authors:   Kuban State Medical University of the Ministry of Health of the Russian Federation, Makukhina T.B. ,   Krasnodar, Russian Federation,   State Budgetary Healthcare Institution "Regional Clinical Hospital No. 2" of the Ministry of Health of the Krasnodar Territory; Krasnodar, Russian Federation, Penzhoyan G.A. ,   Kuban State Medical University of the Ministry of Health of the Russian Federation; Krasnodar, Russian Federation, Model G.Yu. ,   Kuban State Medical University of the Ministry of Health of the Russian Federation; Krasnodar, Russian Federation,   State Budgetary Healthcare Institution "Regional Clinical Hospital No. 2" of the Ministry of Health of the Krasnodar Territory; Krasnodar, Russian Federation, Dontsova M.V. ,   Kuban State University; Krasnodar, Russian Federation
Published: November 2023

Aim: To compare the outcomes of pregnancies with a high risk of placenta accreta depending on the order of delivery in a tertiary obstetric center. Study design: Retrospective single-center cohort comparative study. Materials and methods. We analyzed the outcomes of singleton pregnancies complicated by placenta previa (ICD-10 codes O44.0–O44.1) and suspected placenta accreta (ICD-10 code O43.2) according to antenatal diagnostics at the tertiary Perinatal Center of the State Budgetary Healthcare Institution "KKB No. 2" in Krasnodar in 2014–2020. Cohorts were stratified according to order of delivery. To determine the statistical significance of frequency differences, a two-tailed Fisher test was used. Comparison of two groups on a quantitative basis was made using the Student's t-test for parametric data and the Mann-Whitney U-test for non-parametric data. Comparisons of means of three or more groups were made using the Kruskal-Wallis H test. The relationship between two quantitative characteristics was determined using the Spearman correlation coefficient. Differences were considered statistically significant at p = 0,05. Results. Of the 547 patients, 131 (23,9%) delivered in an emergency manner. During emergency caesarean section (emCS), no statistically significant differences were found in the volume of blood loss during childbirth (p = 0,518 for placenta previa and p = 0,830 for placenta accreta), however, it differed significantly in groups formed by prevalence (p < 0,001) and depth of placental invasion (p < 0,001). Regardless of the presence of placenta previa or placenta accreta, statistically significant differences in the volume of blood loss were associated with different stages of pregnancy (p = 0,013 for placenta previa, p < 0,001 for accreta): a decrease in the volume of blood loss was noted as the gestational age increased (p = –0,303; p < 0,001). Massive blood loss (≥ 1500 ml) increased the risk of hysterectomy (odds ratio = 8,40 (95% confidence interval – 4,99–17,68), p < 0,001). Children born by elective caesarean section (elCS) had higher gestational age, birth weight (p < 0,001) and most parameters characterizing neonatal outcomes. Low birth weight infants were more common in the emCS group (weight ≤ 10th percentile, p = 0,011). Children after elCS at 36+0-6 weeks required oxygen support and transfer to the intensive care unit more often than after elCS at full term (p = 0,020 and p = 0,030, respectively). Conclusion. The urgency of delivery in a tertiary obstetric center with pathological placental attachment does not entail an increase in the volume of blood loss, the number of hysterectomies, or a deterioration in the performance of newborns. The incidence of neonatal complications depends on the gestational age of the fetus (p < 0,001). The presented study substantiates the possibility of prolonging pregnancy until full term (37 weeks) for women who do not have invasive forms of placenta accreta with a low risk of preterm birth. Keywords: placenta accreta, preterm birth, emergency cesarean section, neonatal outcomes, obstetric risk.