Data_Sheet_1_Risk factors of emergency cesarean section in pregnant women with severe placenta accreta spectrum: a retrospective cohort study.docx

IntroductionPlacenta accreta spectrum (PAS) may cause enormous and potentially life-threatening hemorrhage in the intrapartum and postpartum periods in emergency cesarean section. How to reduce the occurrence of emergency cesarean section in patients with severe PAS is the key to reducing the adverse outcomes of them. This study aimed to investigate the impact of emergency cesarean section on the perioperative outcomes of pregnant women with PAS and neonates, and also aimed to explore the risk factors of emergency cesarean section in pregnant women with PAS.
Materials and methodsA retrospective investigation was conducted among 163 pregnant women with severe PAS. Of these, 72 were subjected to emergency cesarean sections. Data on the perioperative characteristics of the mothers and neonates were collected. Multivariable linear regression analysis was used to detect associations between maternal and perioperative characteristics and volume of intraoperative bleeding. Binary logical regression was used to analyze the association between maternal preoperative characteristics and emergency cesarean section. Linear regression analysis is used to analyze the relationship between gestational age and emergency cesarean section.
ResultsThe risks of emergency cesarean section increase 98, 112, 124, and 62% when the pregnant women with PAS accompanied by GHD, ICP, more prior cesarean deliveries and more severe PAS type, respectively. Noteworthy, the risk of emergency cesarean section decreases 5% when pre-pregnancy BMI increases 1 kg/m2 (OR: 0.95; CI: 0.82, 0.98; p = 0.038). Moreover, there is no significant linear correlation between emergency cesarean section and gestational age.
ConclusionGHD, ICP, multiple prior cesarean deliveries and severe PAS type may all increase the risk of emergency cesarean section for pregnant women with PAS, while high pre-pregnancy BMI may be a protective factor due to less activity level. For pregnant women with severe PAS accompanied by these high risk factors, more adequate maternal and fetal monitoring should be carried out in the third trimester to reduce the risk of emergency cesarean section.

引言：胎盘植入谱系（Placenta Accreta Spectrum, PAS）患者在急诊剖宫产的产时及产后阶段，可能发生大量且危及生命的出血。如何降低重症PAS患者急诊剖宫产的发生率，是改善该类患者不良妊娠结局的核心关键。本研究旨在探讨急诊剖宫产对PAS孕妇及其新生儿的围手术期结局的影响，同时分析PAS孕妇发生急诊剖宫产的危险因素。
材料与方法：本研究对163例重症PAS孕妇开展回顾性调查，其中72例接受了急诊剖宫产术。收集产妇及新生儿的围手术期特征相关数据。采用多变量线性回归分析，探究产妇基线与围手术期特征与术中失血量的关联；采用二元logistic回归分析产妇术前特征与急诊剖宫产发生的相关性；采用线性回归分析孕周与急诊剖宫产之间的关联。
结果：当PAS孕妇合并生长激素缺乏症（Growth Hormone Deficiency, GHD）、妊娠期肝内胆汁淤积症（Intrahepatic Cholestasis of Pregnancy, ICP）、既往剖宫产次数增多以及PAS分型病情更严重时，急诊剖宫产风险分别升高98%、112%、124%与62%。值得注意的是，孕前体重指数（Body Mass Index, BMI）每升高1kg/m²，急诊剖宫产风险降低5%（优势比OR=0.95；95%置信区间CI：0.82~0.98；P=0.038）。此外，急诊剖宫产发生率与孕周未发现显著线性相关性。
结论：GHD、ICP、多次既往剖宫产史及重症PAS分型均可升高PAS孕妇急诊剖宫产的发生风险，而孕前高BMI可能因活动水平较低成为保护性因素。对于合并上述高危因素的重症PAS孕妇，应在妊娠晚期开展更为充分的母胎监测，以降低急诊剖宫产的发生风险。