Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.

<h4>Introduction</h4>Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in...

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Autores principales:	Sara Ornaghi, Alice Maraschini, Serena Donati, Regional Obstetric Surveillance System Working Group
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4e1458be2d1840148feed245a43ee24f
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spelling	oai:doaj.org-article:4e1458be2d1840148feed245a43ee24f2021-12-02T20:11:02ZCharacteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.1932-620310.1371/journal.pone.0252654https://doaj.org/article/4e1458be2d1840148feed245a43ee24f2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252654https://doaj.org/toc/1932-6203<h4>Introduction</h4>Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in Europe; nonetheless, there is a paucity of high-quality Italian data on PAS. The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. Also, since severe morbidity and mortality in Italy show a North-South gradient, we assessed and compared perinatal outcomes of women with PAS according to the geographical area of delivery.<h4>Material and methods</h4>This was a prospective population-based study using the Italian Obstetric Surveillance System (ItOSS) and including all women aged 15-50 years with a diagnosis of PAS between September 2014 and August 2016. Six Italian regions were involved in the study project, covering 49% of the national births. Cases were prospectively reported by a trained clinician for each participating maternity unit by electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period.<h4>Results</h4>A cohort of 384 women with PAS was identified from a source population of 458 995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75-0.92). Antenatal suspicion was present in 50% of patients, who showed reduced rates of blood transfusion compared to unsuspected patients (65.6% versus 79.7%, P = 0.003). Analyses by geographical area showed higher rates of both concomitant placenta previa and prior CS (62.1% vs 28.7%, P<0.0001) and antenatal suspicion (61.7% vs 28.7%, P<0.0001) in women in Southern compared to Northern Italy. Also, these women had lower rates of hemorrhage ≥2000 mL (29.6% vs 51.2%, P<0.0001), blood transfusion (64.5% vs 87.5%, P = 0.001), and severe maternal morbidity (5.0% vs 11.1%, P = 0.036). Delivery in a referral center for PAS occurred in 71.9% of these patients.<h4>Conclusions</h4>Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management.Sara OrnaghiAlice MaraschiniSerena DonatiRegional Obstetric Surveillance System Working GroupPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252654 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sara Ornaghi Alice Maraschini Serena Donati Regional Obstetric Surveillance System Working Group Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.
description	<h4>Introduction</h4>Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in Europe; nonetheless, there is a paucity of high-quality Italian data on PAS. The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. Also, since severe morbidity and mortality in Italy show a North-South gradient, we assessed and compared perinatal outcomes of women with PAS according to the geographical area of delivery.<h4>Material and methods</h4>This was a prospective population-based study using the Italian Obstetric Surveillance System (ItOSS) and including all women aged 15-50 years with a diagnosis of PAS between September 2014 and August 2016. Six Italian regions were involved in the study project, covering 49% of the national births. Cases were prospectively reported by a trained clinician for each participating maternity unit by electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period.<h4>Results</h4>A cohort of 384 women with PAS was identified from a source population of 458 995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75-0.92). Antenatal suspicion was present in 50% of patients, who showed reduced rates of blood transfusion compared to unsuspected patients (65.6% versus 79.7%, P = 0.003). Analyses by geographical area showed higher rates of both concomitant placenta previa and prior CS (62.1% vs 28.7%, P<0.0001) and antenatal suspicion (61.7% vs 28.7%, P<0.0001) in women in Southern compared to Northern Italy. Also, these women had lower rates of hemorrhage ≥2000 mL (29.6% vs 51.2%, P<0.0001), blood transfusion (64.5% vs 87.5%, P = 0.001), and severe maternal morbidity (5.0% vs 11.1%, P = 0.036). Delivery in a referral center for PAS occurred in 71.9% of these patients.<h4>Conclusions</h4>Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management.
format	article
author	Sara Ornaghi Alice Maraschini Serena Donati Regional Obstetric Surveillance System Working Group
author_facet	Sara Ornaghi Alice Maraschini Serena Donati Regional Obstetric Surveillance System Working Group
author_sort	Sara Ornaghi
title	Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.
title_short	Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.
title_full	Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.
title_fullStr	Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.
title_full_unstemmed	Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.
title_sort	characteristics and outcomes of pregnant women with placenta accreta spectrum in italy: a prospective population-based cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/4e1458be2d1840148feed245a43ee24f
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Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.

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