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Maternal serum markers, characteristics and morbidly adherent placenta in women with previa

Journal of Perinatology volume 35, pages 570–574 (2015)Cite this article

Subjects

Abstract

Objective:

To examine associations with morbidly adherent placenta (MAP) among women with placenta previa.

Study Design:

Women with MAP (cases) and previa alone (controls) were identified from a cohort of 236 714 singleton pregnancies with both first and second trimester prenatal screening, and live birth and hospital discharge records; pregnancies with aneuploidies and neural tube or abdominal wall defects were excluded. Logistic binomial regression was used to compare cases with controls.

Result:

In all, 37 cases with MAP and 699 controls with previa alone were included. Risk for MAP was increased among multiparous women with pregnancy-associated plasma protein-A (PAPP-A) ⩾95th percentile (⩾2.63 multiple of the median (MoM); adjusted OR (aOR) 8.7, 95% confidence interval (CI) 2.8 to 27.4), maternal-serum alpha fetoprotein (MS-AFP) ⩾95th percentile (⩾1.79 MoM; aOR 2.8, 95% CI 1.0 to 8.0), and 1 and ⩾2 prior cesarean deliveries (CDs; aORs 4.4, 95% CI 1.5 to 13.6 and 18.4, 95% CI 5.9 to 57.5, respectively).

Conclusion:

Elevated PAPP-A, elevated MS-AFP and prior CDs are associated with MAP among women with previa.

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References

  1. Committee on Obstetric Practice. Committee opinion No. 529: placenta accreta. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012; 120: 207–211.

  2. Breen JL, Neubecker R, Gregori CA, Franklin JE . Placenta accreta, increta, and percreta. A survey of 40 cases. Obstet Gynecol 1977; 49 (1): pp43–pp47.

    Google Scholar 

  3. Wortman AC, Alexander JM . Placenta accreta, increta, and percreta. Obstet Gynecol Clin North Am 2013; 40 (1): 137–154.

    Article  PubMed  Google Scholar 

  4. Pridjian G, Hibbard JU, Moawad AH . Cesarean: changing the trends. Obstet Gynecol 1991; 77: 195–200.

    Article  CAS  PubMed  Google Scholar 

  5. Wu S, Kocherginsky M, Hibbard JU . Abnormal placentation: 20-year analysis. Am J Obstet Gynecol 2005; 192: 1458–1461.

    Article  PubMed  Google Scholar 

  6. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA et al. Maternal morbidity associated with multiple repeat cesarean deliveries. National Institute of Child Health and Human Development MFMU. Obstet Gynecol 2006; 107: 1226–1232.

    Article  PubMed  Google Scholar 

  7. Fox H . Placenta accreta, 1945-1969. Obstet Gynecol Surv 1972; 27: 475–490.

    Article  Google Scholar 

  8. Jacques SM, Qureshi F, Trent VS, Ramirez NC . Placenta accreta: mild cases diagnosed by placental examination. Int J Gynecol Pathol 1996; 15: 28–33.

    Article  CAS  PubMed  Google Scholar 

  9. Al-Serehi A, Mhoyan A, Brown M, Benirschke K, Hull A, Pretorius DH . Placenta accreta: an association with fibroids and Asherman syndrome. J Ultrasound Med 2008; 27 (11): 1623–1628.

    Article  PubMed  Google Scholar 

  10. Sharp HT . Endometrial ablation: postoperative complications. Am J Obstet Gynecol 2012; 207 (4): 242–247.

    Article  PubMed  Google Scholar 

  11. Hamar BD1, Wolff EF, Kodaman PH, Marcovici I . Premature rupture of membranes, placenta increta, and hysterectomy in a pregnancy following endometrial ablation. J Perinatol 2006; 26 (2): 135–137.

    Article  CAS  PubMed  Google Scholar 

  12. Pron G, Mocarski E, Bennet J, Vilos G, Common A, Vanderburgh L Ontario UFE Collaborative Group et al. Pregnancy after uterine artery embolization for leiomata: the Ontario multicenter trial. Obstet Gynecol 2005; 105 (1): 67–76.

    Article  PubMed  Google Scholar 

  13. Miller DA, Chollet JA, Goodwin TM . Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177: 210–214.

    Article  CAS  PubMed  Google Scholar 

  14. Clark SL, Koonings PP, Phelan JP . Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985; 66: 89–92.

    CAS  PubMed  Google Scholar 

  15. Wax JR, Seiler A, Horowitz S, Ingardia CJ . Interpregnancy interval as a risk factor for placenta accreta. Conn Med 2000; 64 (11): 659–661.

    CAS  PubMed  Google Scholar 

  16. Kim KR, Jun SY, Kim JY, Ro JY . Implantation site intermediate trophoblasts in placenta cretas. Mod Pathol 2004; 17: 1483–1490.

    Article  PubMed  Google Scholar 

  17. Stanek J, Drummond Z . Occult placenta accreta: the missing link in the diagnosis of abnormal placentation. Pediatr Dev Pathol 2007; 10: 266–273.

    Article  PubMed  Google Scholar 

  18. Miller WG . A clinical and pathological study of placenta accrete. J Obstet Gynaecol Br Emp 1959; 66: 353–364.

    Article  Google Scholar 

  19. Bowman ZS, Eller AG, Bardsley TR, Greene T, Varner MW, Silver RM . Risk Factors for Placenta Accreta: A Large Prospective Cohort. Am J Perinatol 2013; 31 (9): 799–804.

    Article  PubMed  Google Scholar 

  20. Wehrum MJ, Buhimschi IA, Salafia C, Thung S, Bahtiyar MO, Werner EF et al. Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 2011; 204 (5): 411 e1-411.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Tantbirojn P, Crum CP, Parast MM . Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta 2008; 29: 639–645.

    Article  CAS  PubMed  Google Scholar 

  22. Warshak CR, Ramos GA, Eskander R, Scioscia AL, Mattrey RF, Benirschke K et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 2010; 115 (1): 65–69.

    Article  PubMed  Google Scholar 

  23. Eller AG, Porter TF, Soisson P, Silver RM . Optimal management strategies for placenta accreta. BJOG 2009; 116 (5): 648–654.

    Article  CAS  PubMed  Google Scholar 

  24. D'Antonio F, Iacovella C, Palacios-Jaraquemada J, Bruno CH, Manzoli L, Bhide A . Prenatal identification of invasive placentation using magnetic resonance imaging (MRI): a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2014; 44 (1): 8–16.

    Article  CAS  PubMed  Google Scholar 

  25. D'Antonio F1, Iacovella C, Bhide A . Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013; 42 (5): 509–517.

    Article  CAS  PubMed  Google Scholar 

  26. Kupferminc MJ, Tamura RK, Wigton TR, Glassenber R, Socol ML . Placenta accreta is associated with elevated maternal serum alpha-fetoprotein. Obstet Gynecol 1993; 82 (2): 266–269.

    CAS  PubMed  Google Scholar 

  27. Zelop C, Nadel A, Frigoletto FD Jr, Pauker S, MacMillan M, Benacerraf BR . Placenta accreta/percreta/increta: a cause of elevated maternal serum alpha-fetoprotein. Obstet Gynecol 1992; 80 (4): 693–694.

    CAS  PubMed  Google Scholar 

  28. Dreux S, Salomon LJ, Muller F, Goffinet F, Oury JF ABA Study GroupSentilhes L. Second- trimester maternal serum markers and placenta accreta. Prenat Diagn 2012; 32 (10): 1010–1012.

    Article  CAS  PubMed  Google Scholar 

  29. Hung TH, Shau WY, Hsieh CC, Chiu TH, Hsu JJ, Hsieh TT . Risk factors for placenta accreta. Obstet Gynecol 1999; 93 (4): 545–550.

    CAS  PubMed  Google Scholar 

  30. Conover CA . Key questions and answers about pregnancy-associated plasma protein-A. Trends Endocrinol Metab 2012; 235 (5): 242–249.

    Article  Google Scholar 

  31. Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH et al. First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial). Am J Obstet Gynecol 2004; 191 (4): 1446–1451.

    Article  CAS  PubMed  Google Scholar 

  32. Jelliffe-Pawlowski LL, Shaw GM, Currier RJ, Stevenson DK, Baer RJ, O'Brodovich HM et al. Association of early-preterm birth with abnormal levels of routinely collected first- and second- trimester biomarkers. Am J Obstet Gynecol 2013; 208 (6): 492.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Goetzinger KR, Cahill AG, Macones GA, Odibo AO . Association of first-trimester low PAPP-A levels with preterm birth. Prenat Diagn 2010; 30: 309–313.

    CAS  PubMed  Google Scholar 

  34. Gagnon A, Wilson RD . Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can 2008; 30 (10): 918–932.

    Article  PubMed  Google Scholar 

  35. Desai N, Krantz D, Roman A, Fleischer A, Boulis S, Rochelson B . Elevated first trimester PAPP-A is associated with increased risk of placenta accrete. Prenat Diagn 2014; 34: 159–162.

    Article  CAS  PubMed  Google Scholar 

  36. Robinson BK, Grobman WA . Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstet Gynecol 2010; 116: 835–842.

    Article  PubMed  Google Scholar 

  37. Folkersen J, Grudzinskas JG, Hindersson P, Teisner B, Westergaard JG . Pregnancy-associated plasma protein-A: circulating levels during normal pregnancy. Am J Obstet Gynecol 1981; 139: 910–914.

    Article  CAS  PubMed  Google Scholar 

  38. Lawrence JB, Oxvig C, Overgaard MT, Sottrup-Jensen L, Gleich GJ, Hays LG et al. The insulin-like growth factor (IGF) –dependent binding protein-4 protease secreted by human fibroblasts is pregnancy-associated plasma protein-A. Proc Natl Acad Sci USA 1999; 96: 3149–3153.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Smith GCS, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM . Early pregnancy levels of pregnancy-associated plasma protein A and the risk for intrauterine growth restriction, premature birth, preeclampsia and stillbirth. J Clin Endocrinol Metab 2002; 87: 1762–1767.

    Article  CAS  PubMed  Google Scholar 

  40. Blumenfeld YJ, Baer RJ, Druzin ML, El-Sayed YY, Lyell DJ, Faucett AM, Shaw GM, Currier RJ, Jelliffe-Pawlowski LL . Association between maternal characteristics, abnormal serum aneuploidy analytes, and placental abruption. Am J Obstet Gynecol 2014; 211 (2): 144.

    Article  PubMed  Google Scholar 

  41. Berkeley AS, Killackey MA, Cederqvist LL . Elevated maternal serum alpha-fetoprotein levels with breakdown in fetal-maternal-placental barrier. Am J Obstet Gynecol 1983; 146: 859–861.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by California Genetic Disease Screening Program (GDSP) and California Office of Statewide Health Planning and Development, Richmond CA. Dr Lyell received support from the Arline and Pete Harman, Children's Health Research Institute fund at Lucile Packard Children's Hospital at Stanford. This study was presented at the Society for Maternal-Fetal Medicine Annual Meeting on 6 February 2014 in New Orleans, LA.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA

    D J Lyell, Y J Blumenfeld, M L Druzin & Y Y El-Sayed

  2. Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA

    A M Faucett

  3. California Department of Public Health, Genetic Disease Screening Program, Richmond, CA, USA

    R J Baer, R J Currier & L L Jelliffe-Pawlowski

  4. Department of Pediatrics, Stanford University, Stanford, CA, USA

    G M Shaw

  5. Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA

    L L Jelliffe-Pawlowski

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  1. D J Lyell
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Correspondence to D J Lyell.

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Lyell, D., Faucett, A., Baer, R. et al. Maternal serum markers, characteristics and morbidly adherent placenta in women with previa. J Perinatol 35, 570–574 (2015). https://doi.org/10.1038/jp.2015.40

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