Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor?
- PMID: 25957019
- DOI: 10.1016/j.ajog.2015.05.002
Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor?
Abstract
Objective: The purpose of this study was to examine cesarean delivery morbidity and its predictors in the United States.
Study design: We used 2000-2011 Nationwide Inpatient Sample data to identify cesarean deliveries and records with 12 potential cesarean delivery complications, including placenta accreta. We estimated cesarean delivery morbidity rates and rate changes from 2000-2011, and fitted Poisson regression models to assess the relative incidence of morbidity among repeat vs primary cesarean deliveries and explore its predictors.
Results: From 2000-2011, 76 in 1000 cesarean deliveries (97 in 1000 primary and 48 in 1000 repeat cesarean deliveries) were accompanied by ≥1 of 12 complications. The unadjusted composite cesarean delivery morbidity rate increased by 3.6% only among women with a primary cesarean delivery (P < .001); the unadjusted rate of placenta accreta increased by 30.8% only among women with a repeat cesarean deliveries (P = .025). The adjusted rate of overall composite cesarean delivery morbidity decreased by 1% annually from 2000-2011 (P < .001). Compared with women with a primary cesarean delivery, those women who underwent a repeat cesarean delivery were one-half as likely (incidence rate ratio, 0.50; 95% CI, 0.49-0.50) to experience a complication, but 2.13 (95% CI, 1.98-2.29) times more likely to have a placenta accreta diagnosis. Both cesarean delivery morbidity and placenta accreta were positively associated with age >30 years, non-Hispanic black race/ethnicity, the presence of a chronic medical condition, and delivery in urban, teaching, or larger hospitals.
Conclusion: Overall, cesarean delivery morbidity declined modestly from 2000-2011, but placenta accreta became an increasingly important contributor to repeat cesarean delivery morbidity. Clinicians should maintain a high index of suspicion for abnormal placentation and make adequate preparations for patients who need cesarean deliveries.
Keywords: United States; cesarean delivery.
Published by Elsevier Inc.
Similar articles
-
The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality.J Matern Fetal Neonatal Med. 2011 Nov;24(11):1341-6. doi: 10.3109/14767058.2011.553695. Epub 2011 Mar 7. J Matern Fetal Neonatal Med. 2011. PMID: 21381881
-
Risk factors for placenta accreta: a large prospective cohort.Am J Perinatol. 2014 Oct;31(9):799-804. doi: 10.1055/s-0033-1361833. Epub 2013 Dec 12. Am J Perinatol. 2014. PMID: 24338130
-
Maternal morbidity associated with multiple repeat cesarean deliveries.Obstet Gynecol. 2006 Jun;107(6):1226-32. doi: 10.1097/01.AOG.0000219750.79480.84. Obstet Gynecol. 2006. PMID: 16738145
-
Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review.Am J Obstet Gynecol. 2012 Jul;207(1):14-29. doi: 10.1016/j.ajog.2012.03.007. Epub 2012 Mar 10. Am J Obstet Gynecol. 2012. PMID: 22516620 Review.
-
Anesthesia for the repeat cesarean section in the parturient with abnormal placentation: what does an obstetrician need to know?Arch Gynecol Obstet. 2006 Mar;273(6):319-21. doi: 10.1007/s00404-005-0104-0. Epub 2005 Dec 9. Arch Gynecol Obstet. 2006. PMID: 16341867 Review.
Cited by
-
Incisional Small-Bowel Strangulation after a Caesarean Section: A Case Report.Medicina (Kaunas). 2024 Jan 22;60(1):190. doi: 10.3390/medicina60010190. Medicina (Kaunas). 2024. PMID: 38276068 Free PMC article.
-
Placenta Percreta Managed by Ultrasound-Guided Vertical Transfundal Uterine Incision with Hysterectomy: Case Report.Int Med Case Rep J. 2023 Mar 28;16:221-225. doi: 10.2147/IMCRJ.S403052. eCollection 2023. Int Med Case Rep J. 2023. PMID: 37012984 Free PMC article.
-
Health-Related Quality-of-Life among Pregnant Women after First, Second, and Multiple Cesarean Sections in the Perinatal Period: A Short-Term Longitudinal Study.Int J Environ Res Public Health. 2022 Dec 13;19(24):16747. doi: 10.3390/ijerph192416747. Int J Environ Res Public Health. 2022. PMID: 36554628 Free PMC article.
-
The diversity of trophoblast cells and niches of placenta accreta spectrum disorders revealed by single-cell RNA sequencing.Front Cell Dev Biol. 2022 Nov 7;10:1044198. doi: 10.3389/fcell.2022.1044198. eCollection 2022. Front Cell Dev Biol. 2022. PMID: 36420138 Free PMC article.
-
Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder.PLoS One. 2022 Oct 14;17(10):e0276153. doi: 10.1371/journal.pone.0276153. eCollection 2022. PLoS One. 2022. PMID: 36240191 Free PMC article.
MeSH terms
LinkOut - more resources
Full Text Sources
Medical