Perinatal & Pediatric
Placenta accreta spectrum conditions and associated outcomes by gestational age Sabrina Karim* Sabrina Karim Lindsay S. Womack-Martenson Elizabeth A. Clark Carla L. DeSisto Antoinette T. Nguyen Angela Rohan
Introduction: Abnormal placental adherence, including placenta accreta, placenta increta, and placenta percreta—collectively known as placenta accreta spectrum conditions (PAS) —can lead to life-threatening hemorrhage and other adverse outcomes. Despite increasing PAS incidence over time, little is known about its outcomes across multiple gestational ages. We examined national prevalence estimates of PAS overall and by gestational age at delivery, and the prevalence of adverse outcomes among deliveries with PAS across different gestational ages.
Method: This cross-sectional study used Healthcare Cost and Utilization Project National Inpatient Sample data (2016-2020). International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to identify PAS and adverse maternal outcomes among delivery hospitalizations of patients aged 12-55 years for stillbirths and livebirths (weighted N= 17,865,109). We estimated the prevalence of PAS overall and by gestational age at delivery. For those with PAS, we estimated the prevalence of adverse maternal outcomes by gestational age at delivery.
Result: The prevalence of PAS among delivery hospitalizations was 0.12%, with the highest prevalence in deliveries at 28-31 weeks gestation (0.95%). Among deliveries with PAS, the prevalence of adverse outcomes varied by gestational age. Compared with deliveries ≥32 weeks, those at 24-27 and 28-31 weeks had higher prevalences of blood transfusion (36.0% at 24-27 weeks, 32.1% at 28-31 weeks vs 26.2% at ≥32 weeks), hysterectomy (59.9%, 69.4% vs 45.0%), DIC (12.8%, 9.6% vs 4.1%), shock (11.6%, 8.3% vs 4.2%), DIC with blood transfusion or shock (8.7%, 6.8% vs 2.7%), and placental abruption (8.1%, 9.6% vs 2.1%).
Conclusion: The higher prevalence of complications among deliveries with PAS at earlier gestational ages can inform screening practices and quality improvement initiatives for early identification and transfer of care, if necessary.