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Epidemiology

Poster Session 2

(389) Congenital uterine anomalies and placenta accreta spectrum

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Case reports and small studies suggests that congenital uterine anomalies (CUA) are associated with an increased risk of placenta accreta spectrum (PAS). We aimed to evaluate the association between PAS and CUA in a large, population-based study.

Study Design: We performed a retrospective cohort study using the U.S National Inpatient Sample from 2017-2020. ICD-10 codes of delivery admissions greater than 20 weeks’ gestation were used to determine patient exposures and outcomes. A logistic regression model was constructed to adjust for potentially confounding variables including history of a caesarean delivery, age, and placenta previa. A sensitivity analysis was performed including only patients with a code for PAS who also underwent hysterectomy. Data were weighted according to NIS reported sampling weights

Results: The study cohort included 14,165,045 (2,833,010 unweighted) individuals. Congenital uterine anomalies were present in 60,335 (0.43%) individuals. PAS was more frequent in patients with CUAs compared to those without (0.42% vs 0.12%) with an odds ratio of 3.43 (95% confidence interval 2.60-4.54; p< 0.001). When controlling for age, prior caesarean, and placenta previa, the odds of having PAS is higher in those with a CUA (aOR 2.50; 95% CI 1.86-3.37; p< 0.001). In the sensitivity analysis including only individuals with PAS who underwent a hysterectomy, CUAs continued to be associated with PAS (aOR 2.11; 95% CI 1.33-3.34; p=0.001).

Conclusion:


In this large population-based cohort, congenital uterine anomalies were associated with an increased risk of placenta accreta spectrum. Placental implantation is a complex process, which may be modified by CUAs.