{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:21:23Z","timestamp":1793060483690,"version":"4.5.0"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,7,29]],"date-time":"2015-07-29T00:00:00Z","timestamp":1438128000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"NFOG (Nordic Federation of Societies of Obstetrics and Gynaecology)"},{"name":"Clintec, Karolinska Institutet","id":[{"id":"https:\/\/ror.org\/056d84691","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,7]]},"abstract":"\n Objective<\/jats:title>\n \n The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (\n AIP<\/jats:styled-content>\n ) associated with laparotomy in women in the Nordic countries.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Population\u2010based cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting and population<\/jats:title>\n \n A 3\u2010year Nordic collaboration among obstetricians to identify and report on uterine rupture, peripartum hysterectomy, excessive blood loss, and\n AIP<\/jats:styled-content>\n from 2009 to 2012 The Nordic Obstetric Surveillance Study (\n NOSS<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In the\n NOSS<\/jats:styled-content>\n study, clinicians reported\n AIP<\/jats:styled-content>\n cases from maternity wards and the data were validated against National health registries.\n <\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Prevalence, risk factors, antenatal suspicion, birth complications, and risk estimations using aggregated national data.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 205 cases of\n AIP<\/jats:styled-content>\n in association with laparotomy were identified, representing 3.4 per 10\u00a0000 deliveries. The single most important risk factor, which was reported in 49% of all cases of\n AIP<\/jats:styled-content>\n , was placenta praevia. The risk of\n AIP<\/jats:styled-content>\n increased seven\u2010fold after one prior caesarean section (\n CS<\/jats:styled-content>\n ) to 56\u2010fold after three or more\n CS<\/jats:styled-content>\n . Prior postpartum haemorrhage was associated with six\u2010fold increased risk of\n AIP<\/jats:styled-content>\n (95% confidence interval 3.7\u201310.9). Approximately 70% of all cases were not diagnosed antepartum. Of these, 39% had prior\n CS<\/jats:styled-content>\n and 33% had placenta praevia.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Our findings indicate that a lower\n CS<\/jats:styled-content>\n rate in the population may be the most effective way to lower the incidence of\n AIP<\/jats:styled-content>\n . Focused ultrasound assessment of women at high risk will likely strengthen antenatal suspicion. Prior\n PPH<\/jats:styled-content>\n is a novel risk factor associated with an increased prevalence of\n AIP<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Tweetable abstract<\/jats:title>\n \n An ultrasound assessment in women with placenta praevia or prior CS may double the awareness for\n AIP<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.13547","type":"journal-article","created":{"date-parts":[[2015,7,29]],"date-time":"2015-07-29T07:20:36Z","timestamp":1438154436000},"page":"1348-1355","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":300,"title":["Abnormally invasive placenta\u2014prevalence, risk factors and antenatal suspicion: results from a large population\u2010based pregnancy cohort study in the Nordic countries"],"prefix":"10.1111","volume":"123","author":[{"given":"L","family":"Thurn","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology 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Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RI","family":"Bjarnad\u00f3ttir","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Landspitali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AM","family":"Tapper","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Paediatrics University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PE","family":"B\u00f8rdahl","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Haukeland University Hospital University of Bergen Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Gottvall","sequence":"additional","affiliation":[{"name":"Department of Evaluation and Analysis, Epidemiology and Methodological support unit National Board of Health and Welfare Stockholm Sweden"},{"name":"Department 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