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Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries.
BJOG. 2016 Jul; 123(8):1348-55
Publication Type
Journal Article
Video-Audio Media
L Thurn
P G Lindqvist
M Jakobsson
L B Colmorn
K Klungsoyr
R I Bjarnadóttir
A M Tapper
P E Børdahl
K Gottvall
K B Petersen
L Krebs
M Gissler
J Langhoff-Roos
K Källen
Author Affiliation
Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden.
BJOG. 2016 Jul; 123(8):1348-55
Publication Type
Journal Article
Video-Audio Media
Cesarean Section - statistics & numerical data
Cohort Studies
Denmark - epidemiology
Finland - epidemiology
Hysterectomy - statistics & numerical data
Iceland - epidemiology
Norway - epidemiology
Peripartum Period
Placenta Accreta - diagnostic imaging - epidemiology
Postpartum Hemorrhage - epidemiology
Risk factors
Sweden - epidemiology
Ultrasonography, Prenatal
Uterine Rupture - epidemiology
Young Adult
The 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.
Population-based cohort study.
A 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).
In the NOSS study, clinicians reported AIP cases from maternity wards and the data were validated against National health registries.
Prevalence, risk factors, antenatal suspicion, birth complications, and risk estimations using aggregated national data.
A total of 205 cases of AIP in association with laparotomy were identified, representing 3.4 per 10 000 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.
Our 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.
An ultrasound assessment in women with placenta praevia or prior CS may double the awareness for AIP.
CommentIn: BJOG. 2016 May;123(6):1032 PMID 27101265
CommentIn: BJOG. 2016 May;123(6):1031-2 PMID 27101264
CommentIn: BJOG. 2017 Jan;124(1):164-165 PMID 28009121
PubMed ID
26227006 View in PubMed
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