(379) Placenta accreta spectrum disorder and vasa previa: Is there a connection?

Objective: This study assessed the association between placental accreta spectrum (PAS) disorder and vasa previa.

Study Design: This serial cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample in the United States. The study population was 21,517,317 in-hospital deliveries from 2016 to 2021. The exposure status was a diagnosis of PAS. The outcome measure was a diagnosis of vasa previa. Log-Poisson generalized linear model was created to assess the independent exposure-outcome association, adjusted for prior selected clinico-obstetrics characteristics. Sensitivity analysis included PAS subtype-specific evaluation (accreta, increta, and percreta).

Results: Vasa previa was diagnosed in 11,830 patients, corresponding to an incidence of 5.5 per 10,000 deliveries or one in 1,819 deliveries. The prevalence of vasa previa was 180.0 per 10,000 deliveries in patients with PAS and 5.3 per 10,000 deliveries for patients without PAS (P< .001). After controlling for maternal age, race and ethnicity, hypertensive disorder, diabetes mellitus, obesity, prior uterine scar, placenta previa, and multi-fetal gestation, the diagnosis of PAS was associated with nearly a five-fold increased risk for vasa previa (adjusted-prevalence ratio 4.46, 95% confidence interval 4.02-4.95, P< .001). When assessed by PAS subtypes, placenta increta had the highest prevalence rate of vasa previa (5.3, 171.2, 366.1, and 111.1 per 10,000 deliveries, for absence of PAS, accreta, increta, and percreta, respectively, P</em>< .001).

Conclusion: The results of this study suggest that PAS is associated with an increased risk of vasa previa. Careful sonographic examination assessing for vasa previa may be necessary when evaluating patients with high suspicion for PAS. This hypothesis-generating observation is clinically compelling and warrants further investigation prospectively. Furthermore, it is possible that maternal neovascularization secondary to PAS may also occur in the fetoplacental unit vasculature.