Nationwide Assessment of Gestational Age Distribution at Delivery for Patients With Placenta Accreta Spectrum Disorder

OBJECTIVE: To assess the distribution of gestational age at delivery for patients with placenta accreta spectrum (PAS) in the United States. METHODS: This serial cross-sectional study examined 26,375 hospital deliveries with a diagnosis code for PAS identified in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2021. Descriptive analysis was performed to evaluate the distribution of gestational age at delivery of patients with PAS and related obstetric characteristics. The incidence of PAS codes was also assessed among 21,212,493 hospital deliveries. RESULTS: The majority of patients with PAS delivered preterm (before 37 weeks of gestation, 56.9%); 43.1% delivered at term (37 weeks of gestation or more). Compared with patients with PAS who had preterm deliveries, those with PAS who had term deliveries were more likely to deliver vaginally (32.0% vs 6.9%) and in a rural-setting (9.7% vs 2.3%) or small-bed-capacity (18.6% vs 8.4%) hospital and were less likely to have placenta previa (9.3% vs 50.5%) and increta and percreta subtypes (8.6% vs 27.4%) (all P <.001). Incidences of hemorrhage or blood transfusion or both (62.9% vs 71.5%), shock or coagulopathy or both (6.2% vs 9.8%), hysterectomy (25.6% vs 65.3%), urinary tract injury (2.5% vs 10.0%), and maternal mortality (0.0% vs 0.2%) were lower for patients with PAS who had term compared with preterm deliveries (all P <.001). When any hospital deliveries were included in the analysis, 1 in every 804 delivering patients had a diagnosis of PAS. The incidence sharply decreased from 1 in 83-300 hospital deliveries in the preterm period to 1 in 705-3,037 hospital deliveries after 37 weeks of gestation. The incidence of PAS increased by 15.4% (95% CI, 10.7-20.4), from 114.8 to 132.5 per 100,000 hospital deliveries during the 6-year study period ( P trend<.001). CONCLUSION: In this nationwide, cross-sectional study in the United States, nearly 40% of patients with PAS delivered at term and had distinct clinical and obstetric characteristics and outcomes compared with patients with PAS who delivered preterm. Continued increase in the incidence of PAS at the national level calls for attention and evaluation.