Clinical Research
Placenta Accreta Spectrum Management and Outcomes: A Comparative Analysis of Syrian Refugees and Turkish Citizens Giving Birth in a Tertiary Hospital
Abstract
Aim: Placenta accreta spectrum disorders (PAS) are a global threat to maternal well-being. The aim of this study was to assess differences in clinical characteristics and maternal outcomes between Turkish natives and Syrian refugees giving birth with a diagnosis of PAS at a tertiary centre, and to experience the management of this condition in the unique context of Türkiye, home to one of the world's largest refugee populations.
Material and Method: A retrospective study was conducted using the medical records of 228 singleton pregnancies at high risk of PAS, between January 2019 and October 2022. PAS risk assessment was initially performed by ultrasound at mid-trimester, with diagnosis confirmed histologically or clinically, indicating the presence of placental retention following attempted manual removal. The study population was divided into two groups: native and refugee. We investigated disparities in demographic and medical characteristics and primary maternal and neonatal outcomes.
Results: The study found an increased prevalence of previous cesarean delivery (p=0.005), anterior placenta (p<0.000), placenta previa (p=0.047), and deeper placental invasion (increta/percreta) (p<0.000) in the native group (n=161). The native group had a significantly higher rate of estimated blood loss (2093.5±1516.4 mL vs. 714.1±731.6 mL, p<0.000) and peripartum hysterectomy (p=0.005) compared to the refugee group (n=67). The refugee group had a notably higher incidence of delayed diagnosis (p<0.000) and a shorter surgery duration (p=0.027) compared to the native group.
Conclusion: The current study highlights significant differences in patient characteristics and outcomes between native and refugee pregnant women with PAS. Despite facing challenges, these women did not encounter adverse perinatal outcomes, indicating the efficacy of healthcare interventions.
References
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- Luke RK, Sharpe JW, Greene RR. Placenta accreta: the adherent or invasive placenta. Am J Obstet Gynecol. 1966;95:660-8.
- Silver RM, Branch DW. Placenta accreta spectrum. N Engl J Med. 2018;378:1529-36.
- Creanga AA, Bateman BT, Butwick AJ, et al. Morbidity associated with cesarean delivery in the united states: is placenta accreta an increasingly important contributor?. Obstetric Anesthesia Digest. 2016;36:138.
- Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Obstetric Anesthesia Digest. 2014;34:19-20.
- Hacettepe University Institute of Population Studies. 2018 Turkey Demographic and Health Survey. Ankara, Turkey, HUIPS, 2019.
- Eyi EGY, Mollamahmutoglu L. An analysis of the high cesarean section rates in Turkey by Robson classification. J Matern Fetal Neonatal Med. 2021;34:2682-92.
- Baldwin HJ, Patterson JA, Nippita TA, et al. Antecedents of abnormally invasive placenta in primiparous women: risk associated with gynecologic procedures. Obstet Gynecol. 2018;131:227-33.
- Fitzpatrick KE, Sellers S, Spark P, et al. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One. 2012;7:e52893.
- Piñas Carrillo A, Chandraharan E. Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure. Women's Health. 2019;15:1745506519878081.
- O'Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol. 1996;175:1632-8.
- D'Antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2013;42:509-17.
- Buca D, Liberati M, Calì G, et al. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2018;52:304-9.
- Nieto Calvache AJ, Hidalgo A, López MC, et al. Placenta accreta spectrum in vulnerable population: how to provide care for pregnant refugees struggling to access affordable healthcare. J Matern Fetal Neonatal Med. 2022;35:5031-4.
- McCall SJ, El Khoury TC, Ghattas H, et al. Maternal and infant outcomes of Syrian and Palestinian refugees, Lebanese and migrant women giving birth in a tertiary public hospital in Lebanon: a secondary analysis of an obstetric database. BMJ Open. 2023;13:e064859.
- Collins SL, Ashcroft A, Braun T, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 2016;47:271-5.
- Jauniaux E, Ayres‐de‐Campos D, Langhoff‐Roos J, et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146:20-4.
- Collins SL, Alemdar B, van Beekhuizen HJ, et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 2019;220:511-26.
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- Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010;202:335-43.
- Bryant A, Mhyre JM, Leffert LR, et al. The association of maternal race and ethnicity and the risk of postpartum hemorrhage. Anesth Analg. 2012;115:1127-36.
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- Thomas PE, Beckmann M, Gibbons K. The effect of cultural and linguistic diversity on pregnancy outcome. Aust N Z J Obstet Gynaecol. 2010;50:419-22.
- McKeary M, Newbold B. Barriers to care: the challenges for Canadian refugees and their health care providers. J Refug Stud. 2010;23:523-45.
- Erenel H, Aydogan Mathyk B, Sal V, et al. Clinical characteristics and pregnancy outcomes of Syrian refugees: a case–control study in a tertiary care hospital in Istanbul, Turkey. Arch Gynecol Obstet. 2017;295:45-50.
- Benage M, Greenough PG, Vinck P, et al. An assessment of antenatal care among Syrian refugees in Lebanon. Confl Health. 2015;9:8.
- Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Obstetric Anesthesia Digest. 2016;36:31-2.
- Shamshirsaz AA, Fox KA, Erfani H, et al. Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta. Obstet Gynecol. 2018;131:234-41.
- Thang NM, Anh NTH, Thanh PH, et al. Emergent versus planned delivery in patients with placenta accreta spectrum disorders: a retrospective study. Medicine (Baltimore). 2021;100:e28353.
- Senoglu A, Ozturk M, Karacam Z. Cesarean section rates and indications in Turkey: a systematic review and meta-analysis. Asian J Res Nur Health. 2021;4:31-57.
- Carusi DA. The placenta accreta spectrum: epidemiology and risk factors. Clin Obstet Gynecol. 2018;61:733-42.
- Bowman ZS, Eller AG, Bardsley TR, et al. Risk factors for placenta accreta: a large prospective cohort. Am J Perinatol. 2014;31:799-804.
- Matsubara S, Baba Y, Takahashi H. Placenta previa and hemorrhage: the placental location may be an important determinant of the bleeding amount. J Matern Fetal Neonatal Med. 2018;31:1390-1.
- Marcellin L, Delorme P, Bonnet M, et al. Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta. Obstetric Anesthesia Digest. 2019;39:94-6.
- Morgan EA, Sidebottom A, Vacquier M, et al. The effect of placental location in cases of placenta accreta spectrum. Am J Obstet Gynecol. 2019;221:357.e1-5.
Year 2024,
Volume: 6 Issue: 2, 274 - 279, 16.05.2024
Abstract
References
- Usta IM, Hobeika EM, Musa AA, et al. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol. 2005;193:1045-9.
- Luke RK, Sharpe JW, Greene RR. Placenta accreta: the adherent or invasive placenta. Am J Obstet Gynecol. 1966;95:660-8.
- Silver RM, Branch DW. Placenta accreta spectrum. N Engl J Med. 2018;378:1529-36.
- Creanga AA, Bateman BT, Butwick AJ, et al. Morbidity associated with cesarean delivery in the united states: is placenta accreta an increasingly important contributor?. Obstetric Anesthesia Digest. 2016;36:138.
- Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Obstetric Anesthesia Digest. 2014;34:19-20.
- Hacettepe University Institute of Population Studies. 2018 Turkey Demographic and Health Survey. Ankara, Turkey, HUIPS, 2019.
- Eyi EGY, Mollamahmutoglu L. An analysis of the high cesarean section rates in Turkey by Robson classification. J Matern Fetal Neonatal Med. 2021;34:2682-92.
- Baldwin HJ, Patterson JA, Nippita TA, et al. Antecedents of abnormally invasive placenta in primiparous women: risk associated with gynecologic procedures. Obstet Gynecol. 2018;131:227-33.
- Fitzpatrick KE, Sellers S, Spark P, et al. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One. 2012;7:e52893.
- Piñas Carrillo A, Chandraharan E. Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure. Women's Health. 2019;15:1745506519878081.
- O'Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol. 1996;175:1632-8.
- D'Antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2013;42:509-17.
- Buca D, Liberati M, Calì G, et al. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2018;52:304-9.
- Nieto Calvache AJ, Hidalgo A, López MC, et al. Placenta accreta spectrum in vulnerable population: how to provide care for pregnant refugees struggling to access affordable healthcare. J Matern Fetal Neonatal Med. 2022;35:5031-4.
- McCall SJ, El Khoury TC, Ghattas H, et al. Maternal and infant outcomes of Syrian and Palestinian refugees, Lebanese and migrant women giving birth in a tertiary public hospital in Lebanon: a secondary analysis of an obstetric database. BMJ Open. 2023;13:e064859.
- Collins SL, Ashcroft A, Braun T, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 2016;47:271-5.
- Jauniaux E, Ayres‐de‐Campos D, Langhoff‐Roos J, et al. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146:20-4.
- Collins SL, Alemdar B, van Beekhuizen HJ, et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 2019;220:511-26.
- Directorate General for Migration Management (2019) Temporary protection in European Union. Ministry Interior of Turkey, Directorate General for Migration Management. https://en.goc.gov.tr/temporary-protection-in-european-union access date 5.02.2020.
- Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010;202:335-43.
- Bryant A, Mhyre JM, Leffert LR, et al. The association of maternal race and ethnicity and the risk of postpartum hemorrhage. Anesth Analg. 2012;115:1127-36.
- Admon LK, Winkelman TN, Zivin K, et al. Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012–2015. Obstet Gynecol. 2018;132:1158-66.
- Williams DR, Sternthal M. Understanding racial-ethnic disparities in health: sociological contributions. J Health Soc Behav. 2010;51:S15-27.
- Kirby JB, Taliaferro G, Zuvekas SH. Explaining racial and ethnic disparities in health care. Med Care. 2006;44:164-72.
- Egede LE. Race, ethnicity, culture, and disparities in health care. J Gen Intern Med. 2006;21:667-9.
- Thomas PE, Beckmann M, Gibbons K. The effect of cultural and linguistic diversity on pregnancy outcome. Aust N Z J Obstet Gynaecol. 2010;50:419-22.
- McKeary M, Newbold B. Barriers to care: the challenges for Canadian refugees and their health care providers. J Refug Stud. 2010;23:523-45.
- Erenel H, Aydogan Mathyk B, Sal V, et al. Clinical characteristics and pregnancy outcomes of Syrian refugees: a case–control study in a tertiary care hospital in Istanbul, Turkey. Arch Gynecol Obstet. 2017;295:45-50.
- Benage M, Greenough PG, Vinck P, et al. An assessment of antenatal care among Syrian refugees in Lebanon. Confl Health. 2015;9:8.
- Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Obstetric Anesthesia Digest. 2016;36:31-2.
- Shamshirsaz AA, Fox KA, Erfani H, et al. Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta. Obstet Gynecol. 2018;131:234-41.
- Thang NM, Anh NTH, Thanh PH, et al. Emergent versus planned delivery in patients with placenta accreta spectrum disorders: a retrospective study. Medicine (Baltimore). 2021;100:e28353.
- Senoglu A, Ozturk M, Karacam Z. Cesarean section rates and indications in Turkey: a systematic review and meta-analysis. Asian J Res Nur Health. 2021;4:31-57.
- Carusi DA. The placenta accreta spectrum: epidemiology and risk factors. Clin Obstet Gynecol. 2018;61:733-42.
- Bowman ZS, Eller AG, Bardsley TR, et al. Risk factors for placenta accreta: a large prospective cohort. Am J Perinatol. 2014;31:799-804.
- Matsubara S, Baba Y, Takahashi H. Placenta previa and hemorrhage: the placental location may be an important determinant of the bleeding amount. J Matern Fetal Neonatal Med. 2018;31:1390-1.
- Marcellin L, Delorme P, Bonnet M, et al. Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta. Obstetric Anesthesia Digest. 2019;39:94-6.
- Morgan EA, Sidebottom A, Vacquier M, et al. The effect of placental location in cases of placenta accreta spectrum. Am J Obstet Gynecol. 2019;221:357.e1-5.
There are 38 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | May 16, 2024 |
| Submission Date | February 14, 2024 |
| Acceptance Date | May 9, 2024 |
| Published in Issue | Year 2024 Volume: 6 Issue: 2 |
Chief Editors
Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye
Assoc. Prof. Deniz Şenol
Address: Düzce University, Department of Anatomy, Düzce, Türkiye
E-mail: medrecsjournal@gmail.com
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Medical Records Association (Tıbbi Kayıtlar Derneği)
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