RISK-FACTORS AND MORBIDITY IN PATIENTS WITH PLACENTA PREVIA ACCRETA COMPARED TO PLACENTA PREVIA NON-ACCRETA

Background. Placenta accreta is associated with high morbidity and mos t cases occur with placenta previa. This study was carried out in an a ttempt to define risk factors for placenta accreta in cases of placent a previa and to quantify the increased morbidity of placenta previa ac creta in comparison to placenta previa alone. Methods. The records of all patients delivered by cesarean section (CS) for placenta previa an d accreta during the seven-year period from 1990 to 1996, inclusive, w ere reviewed. Data regarding the demographic features, previous CS, th e incidence of hysterectomy and postpartum morbidity were analyzed. Re sults. Out of 23070 deliveries 110 (0.48%) had placenta previa, twelve (0.05%) of whom had placenta previa accreta. There was no significant difference in age and parity. Patients with a history of previous CS showed a significant increase in the incidence of placenta previa accr eta (p=0.001). The percentage of accreta increased linearly from 4.1% in patients with no CS to 60% in patients who had had three or more CS . Postpartum hemorrhage and emergency hysterectomy were significantly higher among the previa accreta patients compared with the previa pati ents alone (p<0.001; p<0.001, respectively). Conclusion. In the presen ce of a previous history of CS, patients with antepartum diagnosis of placenta previa are considered to be at a greater risk for having plac enta accreta. The risk increases with the increase in the number of pr evious CS. Patients with placenta previa accreta have a significantly higher incidence of PPH and are more likely to undergo emergency hyste rectomy.