Impact of placenta previa with placenta accreta spectrum disorder on fetal growth

Journal article

Objectives: To evaluate fetal growth in pregnancies complicated by placenta previa, both with and without PAS, compared to pregnancies with just a low‐lying placenta.

Methods: This was a multicentre retrospective cohort study of singleton pregnancies complicated by placenta previa, both with and without placenta accreta spectrum (PAS), for which maternal characteristics, ultrasound estimated fetal weight and birthweight were available. The control group chosen was singleton pregnancies with a low‐lying placenta (0.5‐2cm from the internal os). For comparison, the study groups were matched for smoking status, ethnic origin and gestational age at delivery. The diagnosis of PAS and depth of invasiveness was confirmed at birth using both a pre‐defined clinical grading score and histopathological examination. Four maternal‐fetal medicine units participated in data collection of diagnosis, treatment, and outcomes.

Results: The study included 82 women with previa‐PAS, subdivided into adherent previa‐PAS (n= 35) and invasive previa‐PAS (n= 47) and 146 women with a placenta previa. There were 64 controls with a low‐lying placenta. There was no significant difference in the incidence of small‐for‐gestational age (SGA) and large‐for‐gestational age (LGA) between the study groups at the different percentiles cut‐off values. The median gestational age at diagnosis was significantly (P=0.002) lower in the placenta previa than in the low‐lying placenta group. No significant difference was found between previa‐PAS and placenta previa groups for any of the variables. The median EFW percentile was significantly higher in the adherent compared to the invasive subgroup (P= 0.048). The actual birthweight percentiles at delivery did not differ significantly (P= 0.804) between the subgroups.

Conclusions: No difference was seen in fetal growth for pregnancies with a previa‐PAS when compared with placenta previa and low‐lying placenta. There was also no increased incidence of either SGA or LGA babies when a placenta previa was complicated by PAS when compared to a previa which separated spontaneously at birth. Neonatal outcome in previa‐PAS is linked to premature delivery and not to impaired fetal growth.

Authors: Jauniaux, E; Dimitrova, I; Kenyon, N; Mhallem, M; Kametas, N

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Ultrasound in Obstetrics and Gynecology
• Volume: 54
• Issue: 5
• Pages: 643-649
• Publication date: 2019-02-19
• Acceptance date: 2019-02-14
• DOI: 10.1002/uog.20244
• EISSN: 1469-0705
• ISSN: 0960-7692
• Language: English
• Keywords: birthweight; increta; percreta; fetal growth; placenta pervia accreta