Correlation between the severity of endometriosis and the occurrence of placenta accreta spectrum in the subsequent pregnancy.

Abstract

Objective: To investigate the correlation between endometriosis (EMs) severity and placenta accreta spectrum (PAS) risk in the subsequent pregnancy.

Method: Clinical records of 2,142 patients who underwent laparoscopic surgery for EMs at Fujian Provincial Maternal and Child Health Hospital from January 2014 to January 2018, who had achieved pregnancy and were delivered, were analyzed. Baseline data, EMs stage, The Revised American Fertility Society (R-AFS) score, levels of serum indexes, and pregnancy and neonatal outcomes were recorded. The outcome of interest was the occurrence of PAS. The correlation between the R-AFS score, endometriosis staging, and PAS was explored, and the R-AFS threshold was identified.

Results: PAS was associated with a higher incidence of chronic pelvic pain (OR = 8.68, 95% CI: 1.18-45.79, P = 0.014) and infertility for >five years (OR = 2.5, 95% CI: 1.35-4.65, P = 0.003), elevated serum levels of cancer antigens, higher incidence of postpartum hemorrhage, and placenta previa (P < 0.05). PAS rate was higher in women with higher EMs staging and R-AFS score and ovarian EMs combined with deep infiltrating endometriosis (DIE) (P < 0.001). After adjusting for confounders, both R-AFS score (AOR = 1.02, 95% CI: 1.01-1.03, P < 0.001) and ovarian EMs with DIE (AOR = 3.31, 95% CI: 1.54-6.67, P = 0.001) were independent risk factors for PAS. R-AFS score of 29 was identified as a threshold for an increased risk of PAS.

Conclusion: The risk of PAS in patients with endometriosis increases with the R-AFS score. PAS is more likely to occur in women with ovarian EMs combined with DIE. It is necessary to implement a specific monitoring program during pregnancy in patients with a history of severe EMs.