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Am J Perinatol
DOI: 10.1055/a-2257-3864
Short Communication

Risk Profiling In Vitro Fertilization Pregnancies that Develop Placenta Accreta Spectrum

Anna M. Modest
1   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Brett D. Einerson
2   Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Albaro J. Nieto
3   Departamento de Ginecología y Obstetricia, Unidad de Alta Complejidad Obstétrica, Fundación Clínica Valle del Lili, Cali, Colombia
,
Vineet K. Shrivastava
4   Department of Obstetrics and Gynecology, Miller Children's & Women's Hospital/Long Beach, Long Beach, California
,
Alireza A. Shamshirsaz
5   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
6   Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
,
Scott A. Shainker 
1   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
on behalf of the Pan American Society for Placenta Accreta Spectrum › Author Affiliations Funding S.A.S. and A.M.M. received funding from the Chase Koch Foundation.
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Abstract

Objective The objective of this study is to assess whether, among a cohort of placenta accreta spectrum (PAS) patients, antenatal suspicion of PAS was less likely in in vitro fertilization (IVF) compared with non-IVF patients. In addition, we aimed to assess whether IVF patients exhibited similar risk factors for PAS compared with non-IVF patients.

Study Design This is an international multicenter retrospective study of patients with pathologically confirmed PAS (accreta, increta, percreta) between 1998 and 2021. PAS patients were identified through a central international PAS database. Antenatal and pathological criteria are specific to each institution. Pregnancies that resulted from IVF were compared with non-IVF pregnancies. Comparisons were made using a chi-square or Fisher's exact test for categorical variables and Wilcoxon rank-sum test for continuous variables.

Results Of the 692 pregnancies included, 44 were in the IVF group and 648 were in the non-IVF group. The IVF group was less likely to have had a prior cesarean delivery (70.5 vs. 91%, p < 0.01) but a similar prevalence of placenta previa (63.6 vs. 68.1%, p = 0.12) compared with the non-IVF group. The IVF group was also less likely to have either a prior cesarean delivery or placenta previa than the non-IVF group (79.5 vs. 95.4%, p < 0.01). Antenatal detection of PAS was less common in the IVF group compared with the non-IVF group (40.9 vs. 60.5%, p < 0.01, respectively), even when adjusted for maternal age, prior cesarean delivery, prior uterine surgery, placenta previa and site (risk ratio: 0.70, 95% confidence interval: 0.62–0.81). The IVF group had less severe pathological disease compared with the non-IVF group (p = 0.02).

Conclusion Pregnant people with PAS who underwent IVF are less likely to have an antenatal suspicion compared with non-IVF patients. This finding may be explained by the lower incidence of prior cesarean deliveries and/or placenta previa as well as less severe forms of PAS.

Key Points

  • IVF group is less likely to have antenatal PAS suspicion.

  • IVF group is less likely to have had prior cesarean delivery.

  • Risk profile for PAS differs in IVF pregnancies.

Keywords

IVF - PAS - antenatal suspicion


Publication History

Received: 27 June 2023

Accepted: 28 January 2024

Accepted Manuscript online:
30 January 2024

Article published online:
19 February 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Creanga AA, Bateman BT, Butwick AJ. et al. Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor?. Am J Obstet Gynecol 2015; 213 (03) 384.e1-384.e11
    CrossrefPubMedGoogle Scholar
  • 2 Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005; 192 (05) 1458-1461
    CrossrefPubMedGoogle Scholar
  • 3 Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One 2012; 7 (12) e52893
    CrossrefPubMedGoogle Scholar
  • 4 American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus no. 7: placenta accreta spectrum. Obstet Gynecol 2018; 132 (06) e259-e275
    CrossrefPubMedGoogle Scholar
  • 5 Mulla BM, Weatherford R, Redhunt AM. et al. Hemorrhagic morbidity in placenta accreta spectrum with and without placenta previa. Arch Gynecol Obstet 2019; 300 (06) 1601-1606
    CrossrefPubMedGoogle Scholar
  • 6 Shamshirsaz AA, Fox KA, Salmanian B. et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015; 212 (02) 218.e1-218.e9
    CrossrefPubMedGoogle Scholar
  • 7 Erfani H, Fox KA, Clark SL. et al. Maternal outcomes in unexpected placenta accreta spectrum disorders: single-center experience with a multidisciplinary team. Am J Obstet Gynecol 2019; 221 (04) 337.e1-337.e5
    CrossrefPubMedGoogle Scholar
  • 8 Shainker SA, Coleman B, Timor-Tritsch IE. et al; Society for Maternal-Fetal Medicine. Electronic address: pubs@smfm.org. Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum. Am J Obstet Gynecol 2021; 224 (01) B2-B14
    CrossrefPubMedGoogle Scholar
  • 9 Silver RM, Landon MB, Rouse DJ. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107 (06) 1226-1232
    CrossrefPubMedGoogle Scholar
  • 10 Salmanian B, Fox KA, Arian SE. et al. In vitro fertilization as an independent risk factor for placenta accreta spectrum. Am J Obstet Gynecol 2020; 223 (04) 568.e1-568.e5
    CrossrefPubMedGoogle Scholar
  • 11 Kaser DJ, Melamed A, Bormann CL. et al. Cryopreserved embryo transfer is an independent risk factor for placenta accreta. Fertil Steril 2015; 103 (05) 1176-84.e2
    CrossrefPubMedGoogle Scholar
  • 12 Modest AM, Toth TL, Johnson KM, Shainker SA. Placenta accreta spectrum: in vitro fertilization and non-in vitro fertilization and placenta accreta spectrum in a Massachusetts cohort. Am J Perinatol 2021; 38 (14) 1533-1539
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Esh-Broder E, Ariel I, Abas-Bashir N, Bdolah Y, Celnikier DH. Placenta accreta is associated with IVF pregnancies: a retrospective chart review. BJOG 2011; 118 (09) 1084-1089
    CrossrefPubMedGoogle Scholar
  • 14 Hecht JL, Baergen R, Ernst LM. et al. Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel. Mod Pathol 2020; 33 (12) 2382-2396
    CrossrefPubMedGoogle Scholar
  • 15 Jauniaux E, Hecht JL, Elbarmelgy RA, Elbarmelgy RM, Thabet MM, Hussein AM. Searching for placenta percreta: a prospective cohort and systematic review of case reports. Am J Obstet Gynecol 2022; 226 (06) 837.e1-837.e13
    CrossrefPubMedGoogle Scholar
  • 16 Shainker SA, Silver RM, Modest AM. et al. Placenta accreta spectrum: biomarker discovery using plasma proteomics. Am J Obstet Gynecol 2020; 223 (03) 433.e1-433.e14
    CrossrefPubMedGoogle Scholar
  • 17 Afshar Y, Dong J, Zhao P. et al. Circulating trophoblast cell clusters for early detection of placenta accreta spectrum disorders. Nat Commun 2021; 12 (01) 4408
    CrossrefPubMedGoogle Scholar
  • 18 Drukker L, Droste R, Ioannou C, Impey L, Noble JA, Papageorghiou AT. Function and safety of SlowflowHD ultrasound doppler in obstetrics. Ultrasound Med Biol 2022; 48 (06) 1157-1162
    CrossrefPubMedGoogle Scholar