Antonia Iacovelli1, Marco Liberati1, Asma Khalil2, Ilan Timor-Trisch3, Martina Leombroni1, Danilo Buca1, Michela Milani1, Maria Elena Flacco4, Lamberto Manzoli5, Francesco Fanfani1, Giuseppe Calì6, Alessandra Familiari7, Giovanni Scambia7, Francesco D'Antonio8,9. 1. Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy. 2. Fetal medicine Unit, Division of Developmental Sciences, St. George's University of London, London, United Kingdom. 3. Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, New York, NY, USA. 4. Local Health Unit of Pescara, Pescara, Italy. 5. Department of Medical Sciences, University of Ferrara, Ferrara, Italy. 6. Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy. 7. Catholic University of the Sacred Heart, Rome, Italy. 8. Women´s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway. 9. Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway.
Abstract
Purpose of the article. To explore the strength of association between different maternal and pregnancy characteristics and the occurrence of abnormally invasive placenta (AIP).Materials and methods: Pubmed, Embase, CINAHL databases were searched. The risk factors for AIP explored were: obesity, age >35 years, smoking before or during pregnancy, placenta previa, prior cesarean section (CS), placenta previa and prior CS, prior uterine surgery, abortion and uterine curettage, in vitro fertilization (IVF) pregnancy and interval between a previous CS, and a subsequent pregnancy. Random-effect head-to-head meta-analyses were used to analyze the data. Results: Forty-six were included in the systematic review. Maternal obesity (Odd ratio, OR: 1.4, 95% CI 1.0-1.8), advanced maternal age (OR: 3.1, 95% CI 1.4-7.0) and parity (OR: 2.5, 95% CI 1.7-3.6), but not smoking were associated with a higher risk of AIP. The presence of placenta previa in women with at least a prior CS was associated with a higher risk of AIP compared to controls, with an OR of 12.0, 95% CI 1.6-88.0. Furthermore, the risk of AIP increased with the number of prior CS (OR of 2.6, 95% CI 1.6-4.4 and 5.4, 95% CI 1.7-17.4 for two and three prior CS respectively). Finally, IVF pregnancies were associated with a high risk of AIP, with an OR of 2.8 (95% CI 1.2-6.8). Conclusion: A prior CS and placenta previa are among the strongest risk factors for the occurrence of AIP.
Purpose of the article. To explore the strength of association between different maternal and pregnancy characteristics and the occurrence of abnormally invasive placenta (AIP).Materials and methods: Pubmed, Embase, CINAHL databases were searched. The risk factors for AIP explored were: obesity, age >35 years, smoking before or during pregnancy, placenta previa, prior cesarean section (CS), placenta previa and prior CS, prior uterine surgery, abortion and uterine curettage, in vitro fertilization (IVF) pregnancy and interval between a previous CS, and a subsequent pregnancy. Random-effect head-to-head meta-analyses were used to analyze the data. Results: Forty-six were included in the systematic review. Maternal obesity (Odd ratio, OR: 1.4, 95% CI 1.0-1.8), advanced maternal age (OR: 3.1, 95% CI 1.4-7.0) and parity (OR: 2.5, 95% CI 1.7-3.6), but not smoking were associated with a higher risk of AIP. The presence of placenta previa in women with at least a prior CS was associated with a higher risk of AIP compared to controls, with an OR of 12.0, 95% CI 1.6-88.0. Furthermore, the risk of AIP increased with the number of prior CS (OR of 2.6, 95% CI 1.6-4.4 and 5.4, 95% CI 1.7-17.4 for two and three prior CS respectively). Finally, IVF pregnancies were associated with a high risk of AIP, with an OR of 2.8 (95% CI 1.2-6.8). Conclusion: A prior CS and placenta previa are among the strongest risk factors for the occurrence of AIP.