Original ArticlesRisk factors for placenta accreta
Section snippets
Materials and methods
Data for this study came from the Taiwan Down Syndrome Screening Group computerized data base. We included women at 14–22 weeks’ gestation screened for Down syndrome using a combination of serum AFP and free β-hCG between January 1, 1994, and June 30, 1997 (n = 10,672), who delivered at our hospital. Gestational age was estimated mostly by ultrasound dating or was assigned on the basis of the first day of the last menstrual period. Pregnancies complicated by multiple gestations (n = 200), overt
Results
Twenty-eight of 9349 women had placenta accreta. Eighteen delivered vaginally and had difficult manual piecemeal removals of their placentas. Ten of those had curettages for retained placental fragments, found by sonography. Ten women were diagnosed during cesarean deliveries. Eight were treated conservatively, and two had total hysterectomies for uncontrollable bleeding after much of their placentas had been removed, and placenta accreta was verified by histologic examination.
Table 1 compares
Discussion
This study was one of the larger ones to assess many different risk factors for placenta accreta. Our study was strong because we were able to adjust for possible confounding factors, thus separating the influence of different risk factors, and to use subject interviews and medical records rather than vital statistics or birth certificates.
Previous observations suggested that cesarean deliveries, uterine surgeries and curettages, multiparity, high gravidity, and female fetal gender were
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