Key result
Congenital uterine anomalies were associated with an increased odds of placenta accreta spectrum during delivery hospitalization (0.42% vs. 0.12%; adjusted OR 2.46, 95% CI 1.87-3.17).
Why the study?
The study was conducted to evaluate the association between congenital uterine anomalies and placenta accreta spectrum in a large, nationally representative sample.
Are congenital uterine anomalies associated with an increased risk of placenta accreta spectrum in pregnant patients?
Cross-Sectional (n=17,594,765)
Yes
Are congenital uterine anomalies associated with an increased risk of placenta accreta spectrum in pregnant patients?
Odds Ratio: 2.46 (95% CI 1.87–3.17)
Absolute Event Rate: 0.42% vs 0.12%
Congenital uterine anomalies are associated with a significantly increased risk of placenta accreta spectrum, highlighting the importance of careful ultrasound screening in this population.
Objective: To evaluate the association between congenital uterine anomalies (CUAs) and placenta accreta spectrum (PAS) in a large, nationally representative sample. Design: Cross-sectional, observational study using the US National Inpatient Sample from 2017 to 2021. Logistic regression models were constructed to evaluate associations between the exposure and the outcome. Predetermined confounding variables included age, history of a cesarean delivery, and placenta previa. A sensitivity analysis was performed including only patients with a code for placenta accreta spectrum who also underwent hysterectomy. Data were weighted according to National Inpatient Sample complex sampling weights to account for year-to-year variation and to extrapolate estimates to the US population. Subjects: Pregnant patients at ≥20 weeks' gestation with International Classification of Disease codes for congenital uterine anomalies or PAS. Exposure: Code for at least 1 of the CUAs. Main Outcome Measures: Code for at least 1 of the types of PAS during delivery hospitalization. Results: The study cohort included 17,594,765 (or 3,518,955 unweighted) individuals. CUAs were present in 78,809 (0.45%, 15,259 unweighted) individuals. PAS was more frequent in patients with CUA than in those without (0.42% vs. 0.12%), with a weighted odds ratio (OR) of 3.36 (95% confidence interval [CI], 2.62-4.32; unweighted OR, 3.37 [95% CI, 2.63-4.31]). When controlling for age, prior cesarean, and placenta previa, the odds of having PAS was higher in those with a CUA than in those without (weighted adjusted OR [aOR], 2.46 [95% CI, 1.87-3.17]; unweighted aOR, 2.44 [95% CI, 1.88-3.16]). In the sensitivity analysis including only individuals with PAS who underwent a hysterectomy, CUA continued to be associated with PAS (weighted aOR, 2.26 [95% CI, 1.52-3.36]; unweighted aOR, 2.26 [95% CI, 1.55-3.31]). Conclusion: In this population-based study, CUAs were associated with an increased odds of PAS. Patients with CUA should have careful screening for PAS at the time of routine obstetric ultrasound.
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Benipal et al. (2025) conducted a cross-sectional in Pregnancy (n=17,594,765). Congenital uterine anomalies vs. No congenital uterine anomalies was evaluated on Placenta accreta spectrum (PAS) during delivery hospitalization (aOR 2.46, 95% CI 1.87-3.17). Congenital uterine anomalies were associated with an increased odds of placenta accreta spectrum during delivery hospitalization (0.42% vs. 0.12%; adjusted OR 2.46, 95% CI 1.87-3.17).
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