Abnormally invasive placentaprevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries
Abnormally invasive placentaprevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries
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DOI：
10.1111/1471-0528.13547
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发表时间：
2016-07-01
影响因子：
5.8
通讯作者：
Kallen, K.
中科院分区：
文献类型：
--
作者：
Thurn, L.;Lindqvist, P. G.;Kallen, K.
目的 目的是调查北欧国家妇女中与剖腹手术相关的异常侵入性胎盘 (AIP) 的患病率、估计危险因素和产前怀疑。设计基于人群的队列研究。背景和人群北欧产科医生之间为期 3 年的合作，旨在识别和报告 2009 年至 2012 年子宫破裂、围产期子宫切除术、失血过多和 AIP 的情况北欧产科监测研究（NOSS）。方法在 NOSS 研究中，临床医生报告了产科病房的 AIP 病例，数据根据国家卫生登记处进行了验证。主要结果指标是患病率、危险因素、产前怀疑、出生并发症以及使用国家汇总数据进行的风险估计。结果总共确定了 205 例与剖腹手术相关的 AIP 病例，即每 10000 例分娩中有 3.4 例。前置胎盘是最重要的一个危险因素，占所有 AIP 病例的 49%。之前进行过一次剖腹产 (CS) 后，AIP 的风险增加了 7 倍，而进行了 3 次或以上剖腹产后，AIP 的风险增加了 56 倍。既往产后出血与 AIP 风险增加六倍相关（95% 置信区间 3.7-10.9）。大约 70% 的病例在产前没有被诊断出来。其中，39% 的患者既往患有 CS，33% 的患者患有前置胎盘。结论我们的研究结果表明，降低人群中的 CS 率可能是降低 AIP 发生率的最有效方法。对高危女性进行聚焦超声评估可能会加强产前怀疑。既往 PPH 是与 AIP 患病率增加相关的新危险因素。Tweetable 摘要对前置胎盘或既往 CS 的女性进行超声评估可能会使 AIP 的认识加倍。Tweetable 摘要对前置胎盘或既往 CS 的女性进行超声评估可能会使 AIP 的认识加倍。本文包括作者见解，视频摘要可在
ObjectiveThe objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries.DesignPopulation-based cohort study.Setting and populationA 3-year Nordic collaboration among obstetricians to identify and report on uterine rupture, peripartum hysterectomy, excessive blood loss, and AIP from 2009 to 2012 The Nordic Obstetric Surveillance Study (NOSS).MethodsIn the NOSS study, clinicians reported AIP cases from maternity wards and the data were validated against National health registries.Main outcome measuresPrevalence, risk factors, antenatal suspicion, birth complications, and risk estimations using aggregated national data.ResultsA total of 205 cases of AIP in association with laparotomy were identified, representing 3.4 per 10000 deliveries. The single most important risk factor, which was reported in 49% of all cases of AIP, was placenta praevia. The risk of AIP increased seven-fold after one prior caesarean section (CS) to 56-fold after three or more CS. Prior postpartum haemorrhage was associated with six-fold increased risk of AIP (95% confidence interval 3.7-10.9). Approximately 70% of all cases were not diagnosed antepartum. Of these, 39% had prior CS and 33% had placenta praevia.ConclusionOur findings indicate that a lower CS rate in the population may be the most effective way to lower the incidence of AIP. Focused ultrasound assessment of women at high risk will likely strengthen antenatal suspicion. Prior PPH is a novel risk factor associated with an increased prevalence of AIP.Tweetable abstractAn ultrasound assessment in women with placenta praevia or prior CS may double the awareness for AIP.Tweetable abstract An ultrasound assessment in women with placenta praevia or prior CS may double the awareness for AIP. This article includes Author Insights, a video abstract available at