Risk Profiling In Vitro Fertilization Pregnancies that Develop Placenta Accreta Spectrum.

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY American journal of perinatology Pub Date : 2025-01-01 Epub Date: 2024-01-30 DOI:10.1055/a-2257-3864

Anna M Modest, Brett D Einerson, Albaro J Nieto, Vineet K Shrivastava, Alireza A Shamshirsaz, Scott A Shainker

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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..

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对发生胎盘早剥的体外受精妊娠进行风险分析。

研究目的本研究的目的是评估在一组 PAS 患者中，与非 IVF 患者相比，IVF 患者产前怀疑 PAS 的可能性是否更低。此外，我们还旨在评估与非 IVF 患者相比，IVF 患者是否表现出类似的 PAS 风险因素：这是一项国际多中心回顾性研究，研究对象是1998-2021年间经病理证实的PAS（acreta、increta、percreta）患者。PAS 患者是通过一个中央国际 PAS 数据库确定的。产前和病理标准由各机构制定。将试管婴儿妊娠与非试管婴儿妊娠进行比较。对分类变量采用卡方检验（Chi-square）或费雪精确检验（Fisher's exact test），对连续变量采用Wilcoxon秩和检验（Wilcoxon rank-sum test）：在纳入的 692 例妊娠中，体外受精组有 44 例，非体外受精组有 648 例。体外受精组之前进行过剖宫产的可能性较小（70.5% 对 91%，p）：与非体外受精患者相比，患有帕金森综合症并接受体外受精的孕妇产前怀疑的可能性较低。这一发现可能是由于剖宫产和/或前置胎盘的发生率较低，以及PAS的严重程度较轻。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.