Grand Rounds

Is IVF an Independent Risk Factor for Placenta Accreta Spectrum?

BACKGROUND AND PURPOSE:

There is evidence that IVF may be associated with placenta accreta spectrum (PAS), particularly with cryopreserved embryo transfer
Salmanian et al. (AJOG, 2020) assessed whether IVF was an independent risk factor for PAS

Retrospective analysis of a prospective, population-based cohort (2012 to 2019)
Participants
- All patients giving birth in a university hospital system
Study design
- Models were designed to predict PAS and adjusted for important risk factors (e.g. placenta previa and previous cesarean delivery)
- Adjusted odds ratios (OR) were calculated from multivariate regression analyses
Primary outcome
- PAS disorder (confirmed by histopathology)

37,461 deliveries
- History of cesarean: 15%
- Placenta previa in their index pregnancy: 0.7%
- IVF pregnancy: 1.5%
The following were identified as independent risk factors for PAS
- IVF: aOR 8.7 (95% CI, 3.8 to 20.3)
- History of prior cesarean: aOR 21.1 (95% CI, 11.4 to 39.2)
- Presence of placenta previa: aOR 94.6 (95% CI, 29.3 to 305.1)
IVF risk was adjusted to consider the number of prior cesarean deliveries | Risk still remained taking in to account prior cesarean delivery vs no cesarean delivery
- 1 prior cesarean deliveries: aOR 10.1 (95% CI, 5.1 to 20.2)
- 2 prior cesarean deliveries: aOR 13.7 (95% CI, 6.3 to 29.9)
- 3 prior caesarean deliveries: aOR 34.5 (95% CI, 14.1 to 84.6)
- 4 prior cesarean deliveries: aOR 49.1 (95% CI, 17.0 to 141.7)

IVF is an independent risk factor for PAS
However, the authors point out that compared to placenta previa and previous cesarean delivery, the clinical importance of IVF is considerably less

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