Risk Factors, Outcome And Management Survey Of Placenta Accreta In 153 Cases: A Five-Year Experience From A Hospital Of Shanghai, China

Objectives: To assess risk factors, outcomes and provide combinations of treatment for placenta accreta in our hospital of Shanghai, China. Methods: Clinical data of 153 women with placenta accreta and 149 controls between January 2010 and January 2015 were retrospectively collected. Univariate and multivariable logistic regression analyses were performed. Results: The maternal age (OR = 1.268, 95% CI: 1.143-1.406), gravidity (twice, OR = 3.435, 95% CI: 1.413-8.350; 3 times, OR = 9.643, 95% CI: 3.901-23.838) and low-lying placenta (OR = 15.952, 95% CI: 4.701-54.127) were independent risk factors for placenta accreta. Postpartum hemorrhage was the main complication in patients with placenta accreta, leading to the requirement for conservative treatments by intrauterine packing with gauze (15, 33.3%)/water bag (15, 9.8%), B-Lynch suture (9, 5.9%), uterine arterial embolization (14, 9.2%), ligation of the ascending branch of the uterine artery (4, 2.6%) intraoperatively, and injection of MTX (105, 68.6%) postoperatively. Neonates born to women with placenta accreta had significantly lower birth weight, Apgar scores at 5 min and higher rates of neonatal asphyxia, but no deaths occurred. Conclusion: Planned delivery and intervention is necessary for women with placenta previa, multiple gravidity and advanced maternal age to prevent adverse outcomes.