(625) Incidence of Placenta Accreta Spectrum in Pregnancies with Placenta Previa and Prior Dilation and Curettage

Risk factors for placenta accreta spectrum (PAS) other than prior cesarean delivery (CD) and placenta previa remain unclear. In those with placenta previa, there is limited data regarding the role of dilation and curettage (D&C) and risk of PAS. We examined whether an association between D&C and PAS in pregnancies with placenta previa exists.

Study Design:

Retrospective cohort study of pregnancies with finding of placenta previa on third trimester ultrasound from 2016 – 2024 and delivery within our hospital system. Pregnancies were divided into group 1: CD≤1 and group 2: CD≥2,  and then subclassified according to history of D&C. PAS was diagnosed based on pathology findings. Logistic regression was performed to calculate adjusted relative risk for PAS controlling for gestational age at delivery.

Results:

A total of 274 pregnancies with third trimester placenta previa and delivery outcomes at our hospital were reviewed. Characteristics including maternal age, parity, BMI, and IVF were similar within groups (Table 1). The rate of PAS was not different among those with and without D&C in group 1 (26% versus 15%, p=0.4) or group 2 (74% versus 67%, p=0.2). Delivery at < 36 weeks was more frequent in those with D&C among group 1 (69% versus 47%, p=0.016), and not different in group 2 (89% vs 83%, p=0.73). Figure 1 demonstrates PAS pathology in both groups according to history of D&C.

Conclusion:

In this cohort of pregnancies with placenta previa, rate of PAS was not changed based on history of D&C. We did note an association with increased placental invasion with history of D&C, although not statistically significant. Interestingly in those with prior CD≤1 and history of D&C, preterm delivery < 36 weeks was 1.5 times more likely than in those without history of D&C. A large trial is needed to evaluate the role of D&C with incidence of PAS and preterm labor.