Abstract
Introduction
: Focal-occult placenta accreta spectrum (PAS) is known to lead to adverse obstetric
morbidity outcomes, however direct comparisons with previa-associated PAS morbidity
are lacking.
Objective
: We sought to compare baseline characteristics, surgical and obstetric morbidity,
and subsequent pregnancy outcomes of patients with focal occult PAS compared to patients
with previa associated accreta.
Study Design
: A retrospective review was conducted of all pathologically confirmed PAS from 2018-2022
at a tertiary care center. Baseline characteristics, surgical, obstetric, and subsequent
pregnancy outcomes were recorded. Focal-occult PAS was compared with previa-associated
PAS across a range of morbidity characteristics including hemorrhagic factors, interventions,
post-delivery re-operations, infections, and ICU admission. Statistical comparison
was performed using Kruskal-Wallis/Chi-Square tests, and p <0.05 was considered significant.
Results
: 74 cases were identified; 43 focal-occult and 31 previa-associated PAS. 25.6% focal-occult
vs 100% previa-associated PAS underwent hysterectomy. 1 focal-occult and 29 previa-associated
PAS were diagnosed antenatally. Patients with focal-occult PAS did not differ from
previa-associated PAS in mean maternal age (33.0 vs 33.1 years), BMI (Body Mass Index),
or presence of previous dilation & curettage procedure (16.3% vs 25.8%) when compared
to previa-associated PAS. Focal-occult PAS patients were significantly more likely
to have a lower mean parity (1.5 vs 3.6 gestations), higher gestational age at delivery
(36.1 vs 33.9 weeks), were less likely to have had a previous cesarean (12/43, 27.9%
vs 30/31, 96.8%). Additionally, focal-occult PAS patients had fewer number of previous
cesareans (mean 0.5 vs 2.3), were more likely to have had in-vitro fertilization (IVF)
(20.9% vs 3.2%) and less likely to have anterior placentation. When contrasting clinical
outcomes of focal-occult to previa-associated PAS, postpartum hemorrhage rates (71.0%
vs 67.4%), mean quantitative blood loss 2099 mL (range 500-9516mL) vs 2119 mL (range
350-12,220 mL), mean units red blood cells transfused (1.4 vs 1.7), massive transfusion
rate (9.3% vs 3.2%), ICU admission (11.6% vs 6.5%), were not significantly different,
with a non-significant trend towards higher morbidity in focal-occult accreta patients.
Focal occult accreta had higher incidence of reoperation/return to the OR (30.2 vs
6.5%, p=0.01). When comparing focal-occult to previa-associated PAS, the composite
outcomes, including hemorrhagic morbidity (77.4% vs 74.4%), any maternal morbidity
(83.9% vs 76.7%) and severe maternal morbidity (64.5% vs 65.1%) were not significantly
different between groups. Nine focal-occult PAS patients had a subsequent pregnancy,
and three of those had recurrent PAS.
Conclusion/Implications
: Focal-occult PAS presents with fewer identifiable risk factors than placenta previa-associated
PAS but may be associated with IVF pregnancy. Focal-occult PAS was observed to have
higher incidence of reoperation when compared to previa-associated PAS, and no other
statistically significant differences in morbidity outcomes were observed. The absence
of different morbidity outcomes may be attributable to a lack of antenatal detection
of focal occult accreta, and merits further investigation.
Keywords
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Article info
Publication history
Accepted:
March 6,
2023
Received in revised form:
March 3,
2023
Received:
January 27,
2023
Publication stage
In Press Accepted ManuscriptFootnotes
Disclosures: Dr. Theiler discloses support and advisory roles for: HeraMed, Delfina Care and Butterfly Network. The remainder of the authors report no disclosures.
Funding: No funding received
Presentation: This data was presented at ACOG Annual Clinical and Scientific Meeting, May 6-11th, 2022 in San Diego, CA.
Condensation: Retrospective comparison of focal occult to previa associated accreta shows higher rates of in-vitro fertilization and higher reoperation in focal accreta, with no other significant differences in morbidity.
Disclosures: One co-author discloses support and advisory roles for: HeraMed, Delfina Care and Butterfly Network. The remainder of the authors report no disclosures.
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