From the Guidelines
The patient is at increased risk for placenta accreta (option C). This condition is a serious obstetric complication that can lead to severe hemorrhage and even life-threatening consequences during delivery. According to the study by Poder et al 1, the incidence of placenta accreta spectrum disorder (PASD) has increased over the past decades, with a significant risk factor being prior cesarean delivery, which increases the risk of PASD 7-fold after one prior cesarean delivery to 56-fold after 3 cesarean deliveries. Some key points to consider include:
- The risk of severe and even life-threatening hemorrhage is greatest at the time of delivery when a portion of the placenta does not separate in the usual fashion 1.
- Placenta previa is the single most important risk factor for PASD and was present in 49% of cases, as reported by the Nordic Obstetric Surveillance Study 1.
- Accurate antenatal diagnosis is needed to plan for an appropriate delivery strategy at an experienced center in order to reduce maternal morbidity 1.
- Management of delivery is variable, but the American Congress of Obstetricians and Gynecologists (ACOG) and FIGO recommend planned cesarean delivery with or without hysterectomy depending on the suspected severity of PASD around 34 to 38 weeks 1. Given the potential severity of placenta accreta, it is essential to identify high-risk patients and manage them accordingly to minimize morbidity and mortality.
From the Research
Obstetric Complications
The patient is at increased risk for the following obstetric complications:
- Preterm delivery: Studies have shown that respiratory distress syndrome is associated with preterm birth 2, 3, 4.
- Preterm prelabor rupture of membranes: Tocolytics for preterm premature rupture of membranes have been shown to increase latency, but not improve perinatal mortality 5.
- Fetal respiratory distress syndrome: This condition is a common cause of neonatal respiratory failure and death, and is associated with preterm birth 2, 3, 6, 4.
- Polyhydramnios: Although not directly mentioned in the studies, polyhydramnios can be associated with preterm labor and fetal distress.
- Placenta accreta: Not directly mentioned in the studies, but can be associated with preterm birth and fetal distress.
- Fetal neural tube defect: Not directly mentioned in the studies, but can be associated with preterm birth and fetal distress.
- Fetal macrosomia: Not directly mentioned in the studies as a complication associated with the patient's condition.
Key Findings
- Respiratory distress syndrome is associated with increased morbidity and mortality in preterm births 2, 3, 6, 4.
- Antenatal corticosteroids can reduce rates of neonatal mortality and respiratory distress syndrome in low- and middle-income countries 4.
- Tocolytics for preterm premature rupture of membranes can increase latency, but may not improve perinatal mortality 5.