Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study

Autor: Ornaghi S., Maraschini A., Donati S., D'Aloja P., Lega I., Basevi V., Cali G., Dardanoni G., Dubini V., Lupi C., Martinelli P., Mondo L., Pezzella M., Puglia M., Rusciani R., Spettoli D., Voller F.
Přispěvatelé: Ornaghi, S, Maraschini, A, Donati, S, D'Aloja, P, Lega, I, Basevi, V, Cali, G, Dardanoni, G, Dubini, V, Lupi, C, Martinelli, P, Mondo, L, Pezzella, M, Puglia, M, Rusciani, R, Spettoli, D, Voller, F
Rok vydání: 2021
Předmět:
Embryology
European People
Critical Care and Emergency Medicine
Blood transfusion
Epidemiology
Maternal Health
Placenta
medicine.medical_treatment
Placenta Previa
Vascular Medicine
Cohort Studies
Labor and Delivery
Pregnancy
Risk Factors
Medicine and Health Sciences
Prevalence
Ethnicities
Prospective Studies
education.field_of_study
Multidisciplinary
Obstetrics
Gynecologic Surgery
Obstetrics and Gynecology
placenta
cesarean
Hematology
Severe Blood Loss
Middle Aged
Clinical Laboratory Sciences
Italian People
Italy
Cohort
Medicine
Female
Electronic data
Anatomy
Research Article
Adult
medicine.medical_specialty
Adolescent
Referral
Placenta accreta
Science
Population
Surgical and Invasive Medical Procedures
Hemorrhage
Placenta Accreta
Hysterectomy
Young Adult
Signs and Symptoms
Diagnostic Medicine
medicine
Humans
Blood Transfusion
education
Transfusion Medicine
Cesarean Section
business.industry
Postpartum Hemorrhage
Reproductive System
Biology and Life Sciences
medicine.disease
Placenta previa
Health Care
Medical Risk Factors
Concomitant
People and Places
Birth
Women's Health
Population Groupings
Clinical Medicine
Health Statistics
Morbidity
business
Developmental Biology
Zdroj: PLoS ONE, Vol 16, Iss 6, p e0252654 (2021)
PLoS ONE
ISSN: 1932-6203
Popis: Introduction Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in Europe; nonetheless, there is a paucity of high-quality Italian data on PAS. The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. Also, since severe morbidity and mortality in Italy show a North-South gradient, we assessed and compared perinatal outcomes of women with PAS according to the geographical area of delivery. Material and methods This was a prospective population-based study using the Italian Obstetric Surveillance System (ItOSS) and including all women aged 15–50 years with a diagnosis of PAS between September 2014 and August 2016. Six Italian regions were involved in the study project, covering 49% of the national births. Cases were prospectively reported by a trained clinician for each participating maternity unit by electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. Results A cohort of 384 women with PAS was identified from a source population of 458 995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75–0.92). Antenatal suspicion was present in 50% of patients, who showed reduced rates of blood transfusion compared to unsuspected patients (65.6% versus 79.7%, P = 0.003). Analyses by geographical area showed higher rates of both concomitant placenta previa and prior CS (62.1% vs 28.7%, PPPP = 0.001), and severe maternal morbidity (5.0% vs 11.1%, P = 0.036). Delivery in a referral center for PAS occurred in 71.9% of these patients. Conclusions Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management.
Databáze: OpenAIRE
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