OBJECTIVE: 

To evaluate whether there are differences in risk factors and maternal outcomes of pregnancies complicated by placenta accreta spectrum depending on the presence or absence of placenta previa.

DATA SOURCES: 

We performed a systematic search in Medline, EMBASE, ClinicalTrials.gov, and Web of Science from inception through April 25, 2022, without language or date restrictions. Search strategy included the key words “placenta accreta,” “placenta increta,” “placenta percreta,” “adherent placenta,” “invasive placenta,” “abnormal placent*,” “placenta previa,” and “marginal placent*.”

METHODS OF STUDY SELECTION: 

Of the 1,122 articles screened, seven studies were included in the final review. Studies were included if they compared the risk factors and maternal outcomes of pregnancies complicated by placenta accreta spectrum depending on the presence or absence of placenta previa.

TABULATION, INTEGRATION, AND RESULTS: 

A random-effects model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% CIs using RevMan software. A total of 3,342 pregnancies complicated by placenta accreta spectrum were included in the meta-analysis (2,365 without previa and 977 with previa). Pregnancies complicated by placenta accreta spectrum without previa were more likely to have been conceived by in vitro fertilization (IVF) (OR 3.11, 95% CI 1.93–5.02, P<.001, I²=52.0%) and to be associated with prior dilation and curettage (D&C) (OR 1.60, 95% CI 1.15–2.22, P=.005, I²=0.0%) and myomectomy (OR 2.47, 95% CI 1.31–4.66, P=.005, I²=0.0%), but they were less likely to be associated with prior cesarean delivery (OR 0.15, 95% CI 0.06–0.37, P<.001, I²=87.0%). Placenta accreta spectrum without previa was less likely to be diagnosed antenatally (OR 0.07, 95% CI 0.04–0.11, P<.001, I²=38.0%). Also, women with pregnancies without previa had lower rates of red blood cell transfusion, intensive care unit admission, risk of hysterectomy, unscheduled delivery, and intraoperative bowel or bladder injuries.

CONCLUSION: 

Pregnancies complicated by placenta accreta spectrum without previa had a more prominent association with IVF and prior D&C and myomectomy but were much less likely to be associated with prior cesarean delivery. Further, placenta accreta spectrum without previa was less likely to be diagnosed antenatally, although it had better maternal outcomes as compared with placenta accreta spectrum with previa.

SYSTEMATIC REVIEW REGISTRATION: 

PROSPERO, CRD42022307637.

中文翻译：

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胎盘植入谱系疾病的临床相关性取决于是否存在前置胎盘：一项系统评价和荟萃分析

客观的： 

评估是否存在前置胎盘存在或不存在的胎盘植入谱并发妊娠的危险因素和母体结局是否存在差异。

数据源： 

从开始到 2022 年 4 月 25 日，我们在 Medline、EMBASE、ClinicalTrials.gov和 Web of Science 中进行了系统搜索，没有语言或日期限制。搜索策略包括关键词“植入性胎盘”、“植入性胎盘”、“穿透性胎盘”、“粘附性胎盘”、“侵入性胎盘”、“异常胎盘*”、“前置胎盘”和“边缘胎盘*”。

研究选择方法： 

在筛选的 1,122 篇文章中，有 7 项研究被纳入最终审查。如果研究根据前置胎盘的存在与否比较了植入性胎盘并发妊娠的危险因素和母体结局，则研究被纳入。

制表、积分和结果： 

使用 RevMan 软件，使用随机效应模型合并平均差或比值比 (OR) 和相应的 95% CI。共有 3,342 例并发胎盘植入谱的妊娠被纳入荟萃分析（2,365 例无前置胎盘，977 例有前置胎盘）。没有前置胎盘并发胎盘植入谱的妊娠更有可能通过体外受精 (IVF) 受孕（OR 3.11，95% CI 1.93–5.02，P <.001，I ² =52.0%），并且与既往史相关扩张和刮除术 (D&C)（OR 1.60，95% CI 1.15–2.22，P =.005，I ² =0.0%）和子宫肌瘤切除术（OR 2.47，95% CI 1.31–4.66，P =.005，I ²=0.0%），但它们不太可能与之前的剖宫产相关（OR 0.15，95% CI 0.06–0.37，P <.001，I ² =87.0%）。没有前置胎盘的胎盘植入谱不太可能在产前被诊断出来 (OR 0.07, 95% CI 0.04–0.11, P <.001, I ² =38.0%)。此外，在没有前置胎记的情况下怀孕的女性红细胞输注率、重症监护病房入院率、子宫切除术风险、计划外分娩率以及术中肠或膀胱损伤率较低。

结论： 

没有前置胎盘并发胎盘植入谱的妊娠与 IVF 和既往 D&C 和子宫肌瘤切除术有更显着的相关性，但与既往剖宫产相关的可能性要小得多。此外，没有前置胎盘的胎盘植入谱不太可能在产前被诊断出来，尽管与前置胎盘植入谱相比，它具有更好的母体结局。

系统审查注册： 

普洛斯彼罗，CRD42022307637。