{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:45:21Z","timestamp":1782927921912,"version":"3.54.5"},"reference-count":13,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>\n            Objective\u2003Delivery timing at 34 to 36 weeks is nationally recommended for pregnancies complicated by placenta accreta spectrum (PAS). However, it has recently been suggested that those with \u22652 prior cesarean deliveries (CD) and PAS should be delivered earlier than 34 weeks because of a higher risk of unscheduled delivery and complications. We sought to evaluate whether the number of prior CD in women with PAS is associated with early preterm delivery (PTD) (&lt;34 weeks). We also evaluated the same relationship in women with placenta previa alone (without PAS).<\/jats:p><jats:p>\n            Study Design\u2003This is a secondary analysis of a multicenter and observational study that included women with prior CD (maternal\u2013fetal medicine unit cesarean registry). Women with a diagnosis of PAS (regardless of placenta previa) were included for our primary analysis, and women with known placenta previa (without a component of PAS) were independently analyzed in a second analysis. Two groups of patients from the registry were studied: patients with PAS (regardless of placenta previa) and patients with placenta previa without PAS. The exposure of interest was the number of prior CD: \u22652 CD compared with &lt;2 CD. The primary outcome was PTD &lt;34 weeks. Secondary outcomes included preterm labor requiring hospitalization or tocolysis, transfusion of blood products, composites of maternal and neonatal morbidities, and NICU admission. Outcomes by prior CD number groups were compared in both cohorts. Backward selection was used to identify parsimonious logistic regression models.<\/jats:p><jats:p>\n            Results\u2003There were 194 women with PAS, 97 (50%) of whom had &lt;2 prior CD and 97 (50%) of whom had \u22652 prior CD. The rate of PTD &lt;34 weeks in women with \u22652 prior CD compared with &lt;2 in the setting of PAS was 23.7 versus 29.9%, p\u2009=\u20090.27; preterm labor requiring hospitalization was 24.7 versus 13.5%; p\u2009=\u20090.05. The rates of plasma transfusion were increased with \u22652 prior CD (29.9 vs. 17.5%, p\u2009=\u20090.04), but there were no differences in transfusion of other products or in composite maternal or neonatal morbidities. After multivariable adjustments, having \u22652 CDs was not associated with PTD &lt;34 weeks in women with PAS (adjusted odds ratio (aOR): 0.73, 95% confidence interval [CI]: 0.39\u201313.8) despite an association with preterm labor requiring hospitalization (aOR: 2.69; 95% CI: 1.15\u20136.32). In our second analysis, there were 687 women with placenta previa, 633 (92%) with &lt;2 prior CD, and 54 (8%) with \u22652 prior CD. The rate of PTD &lt;34 weeks with \u22652 CD in the setting of placenta previa was not significantly increased (27.8 vs. 22.1%, aOR: 1.49; 95% CI: 0.77\u20132.90, p\u2009=\u20090.08); the maternal composite outcome (aOR: 4.85; 95% CI: 2.43\u20139.67) and transfusion of blood products (aOR: 6.41; 95% CI: 2.30\u201317.82) were noted to be higher in the group with \u22652 prior CD.<\/jats:p><jats:p>\n            Conclusion\u2003Women with PAS who have had \u22652 prior CD as compared with women with &lt;2 prior CD did not appear to have a higher risk of complications leading to delivery prior to 34 weeks. As such, considering the associated morbidity with early preterm birth, we would not recommend scheduled delivery prior to 34 weeks in this population.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0040-1717107","type":"journal-article","created":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T23:01:51Z","timestamp":1601420511000},"page":"326-331","source":"Crossref","is-referenced-by-count":6,"title":["Association between Number of Prior Cesareans and Early Preterm Delivery in Women with Abnormal Placentation"],"prefix":"10.1055","volume":"38","author":[{"given":"Ayamo","family":"Oben","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth B.","family":"Ausbeck","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa N.","family":"Gazi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akila","family":"Subramaniam","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorie M.","family":"Harper","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff M.","family":"Szychowski","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan T.","family":"Tita","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,9,29]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.ajog.2014.11.018","article-title":"Center of excellence for placenta accreta","volume":"212","author":"R M Silver","year":"2015","journal-title":"Am J Obstet 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Engl J Med"},{"issue":"13","key":"ref9","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1056\/NEJMoa1602044","article-title":"Adjunctive azithromycin prophylaxis for cesarean delivery","volume":"375","author":"A T Tita","year":"2016","journal-title":"N Engl J Med"},{"issue":"02","key":"ref10","first-page":"132","article-title":"Recommendations for the transfusion of plasma and platelets","volume":"7","author":"G Liumbruno","year":"2009","journal-title":"Blood Transfus"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.ajog.2005.06.037","article-title":"Placenta previa-accreta: risk factors and complications","volume":"193","author":"I M Usta","year":"2005","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1016\/j.ajog.2004.12.074","article-title":"Abnormal placentation: twenty-year analysis","volume":"192","author":"S Wu","year":"2005","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/01.AOG.0000219750.79480.84","article-title":"Maternal morbidity associated with multiple repeat cesarean deliveries","volume":"107","author":"R M Silver","year":"2006","journal-title":"Obstet Gynecol"}],"container-title":["American Journal of 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