Clinical risk factors for placenta previa–placenta accreta☆,☆☆,★
Section snippets
Material and methods
Hospital records were reviewed of all cases of placenta accreta confirmed by histologic examination of hysterectomy specimens between Jan. 1, 1985, and Dec. 31, 1994. Additionally, we reviewed the records of all women undergoing cesarean hysterectomy and all women with placenta previa during the same period. Multiple logistic regression analysis was used to identify independent risk factors for placenta accreta. Relative risks were calculated with Taylor series 95% confidence intervals. A p
Results
During the study period, there were 155,670 deliveries at Los Angeles County/University of Southern California Women's Hospital. One hundred twenty-seven (1/1226) cesarean hysterectomies were performed with an operative diagnosis of placenta accreta. In 65 cases (52%) histologic findings did not confirm the diagnosis of placenta accreta. The remaining 62 cases (48%) were confirmed histologically and are the subjects of our report. Among these, 47 were placenta accreta, 11 were placenta increta,
Comment
Although earlier reports accepted clinical recognition of abnormal placental adherence as the basis for diagnosis of placenta accreta,3, 4 recent studies have distinguished between suspected and histologically confirmed cases.1, 5, 6, 7 In this series clinical suspicion of placenta accreta was an unreliable predictor of histologic findings, correctly identifying only 48% of cases. Therefore we confined our analysis to histologically confirmed cases. We recognize that exclusion of unconfirmed
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From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Los Angeles County/University of Southern California Women's and Children's Hospital.
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Reprint requests: David A. Miller, MD, LAC+USC Women's and Children's Hospital, Department of Obstetrics and Gynecology, Room 5K-40, 1240 North Mission Road, Los Angeles, CA 90033.
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