In vitro fertilization and placenta accreta spectrum in pregnancies with a history of cesarean delivery

The cesarean delivery (CD) rate in China has risen sharply during the past decade, from 28.8% 2008 to 36.7% 2018.1Li H.T. Hellerstein S. Zhou Y.B. Liu J.M. Blustein J. Trends rates China, 2008-2018.JAMA. 2020; 323: 89-91Crossref PubMed Scopus (26) Google Scholar As relaxed its 1 child policy, proportion of pregnant women with a previous CD almost doubled, increasing 9.8% 2012 17.7% 2016.2Liang Mu Y. Li X. et al.Relaxation one policy and trends caesarean section birth outcomes between 2016: observational study nearly seven million health facility births.BMJ. 2018; 360: k817Crossref (80) vitro fertilization (IVF) pregnancies confer an increased risk adverse obstetrical outcomes. uterine scar secondary is main cause placenta accreta spectrum (PAS).3Jauniaux E. Collins Burton G.J. Placenta spectrum: pathophysiology evidence-based anatomy for prenatal ultrasound imaging.Am J Obstet Gynecol. 218: 75-87Abstract Full Text PDF (217) To accurately evaluate PAS IVF non-IVF critical allowing proper counseling, preparation, optimizing We read great interest entitled “In as independent factor spectrum” by Salmanian al.4Salmanian B. Fox K.A. Arian S.E. al.In spectrum.Am 223: 568.e1-568.e5Abstract (15) agree association development absence previa (PP) CD. However, based on our multicenter, cross-sectional cohort 14,734 CD,5Bi Zhang L. Chen al.Maternal age at first related pregnancy second delivery: historical, study.BMC Pregnancy Childbirth. 2021; 21: 126Crossref (1) we found that was not After excluding incomplete data, twin or multiple pregnancies, major fetal abnormalities, antepartum death, 9634 singleton were enrolled, which 192 (1.99%) 520 (5.40%) PAS. frequency group (1.73%) similar non-PAS (2.01%). Besides, incidence slightly lower (4.69%) than (5.41%). PP most important this (adjusted odds ratio, 394.45; 95% confidence interval, 157.95–985.09). Similar Salmanian’s among without concurrent PP, (2.26%) higher (0.84%). 15 patients setting, 5 (33.33%) had In cohort, all CDs, index (100%).4Salmanian addition, incision types may interfere location attachment, so analyzed presence (Table). A total 8928 only enrolled. although difference significant, transverse both (52.53 vs 66.67%; P = .173) (33.33 52.53%; .187). Unfortunately, detailed attachment data sample small cohort. Despite these limitations, suggest CD, particularly incision. Our findings be helpful clinical counseling preparation situation. further larger population necessary connection PAS, considering types, help understand mechanism pathogenesis PAS.TableFrequency (N=8928)Previous incisionPlacenta previaTotal numberPAS (%)Patient pregnancyNoNo70 (0.00)aTwo groups compared separatelyYesNo1574 (2.55)bTwo separately,eP<.05.NoYes21 (50.00)cTwo separatelyYesYes124 (33.33)dTwo separatelyPatient pregnancyNoNo4620 separatelyYesNo765059 (0.77)bTwo separatelyNoYes2416 (66.67)cTwo separatelyYesYes613332 (52.53)dTwo separatelyData are expressed number (percentage).CD, delivery; IVF, fertilization; spectrum.Du. pregnancies. Am Gynecol 2021.a,b,c,d Two separatelye P<.05. Open table new tab Data (percentage). spectrum. Du. 2021. This supported grants National Key R&D Program (No. 2016YFC1000405, 2017YFC1001402, 2018YFC10029002) Natural Science Foundation 81830045 82071652). spectrumAmerican Journal Obstetrics & GynecologyVol. 223Issue 4PreviewPlacenta well known catastrophic maternal defined. There have been emerging Full-Text different populationsAmerican 225Issue 2PreviewWe would like thank Du al their manuscript spectrum.” Their communication outlines results program suggesting (PAS) subgroup (CD). Given differences demographics, practice patterns, history diagnosis methodology size, analysis, correct environment population, but representative any population.