INCREASED CESAREAN SECTION RATES AND THE SPECTRUM OF PLACENTAL ACCRETA: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv17n56-049Keywords:
Cesarean Section, Placenta Accreta, Obstetric Hemorrhage, Maternal MorbidityAbstract
Introduction: The progressive global increase in cesarean section rates has been accompanied by a marked rise in abnormal placental adherence disorders, collectively referred to as placenta accreta spectrum, which are associated with severe maternal morbidity, mortality, and substantial healthcare burden.
Objective: The main objective of this systematic review was to evaluate the association between increasing cesarean section rates and the incidence and severity of placenta accreta spectrum disorders, while secondary objectives included assessing dose-dependent risk related to multiple cesarean deliveries, maternal clinical outcomes, diagnostic strategies, management approaches, and implications for obstetric practice and health systems.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, the Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform, including studies published within the last five years. Eligible studies evaluated cesarean delivery history and placenta accreta spectrum outcomes in human populations, with no language restriction. Study selection followed PRISMA guidelines, and evidence was synthesized qualitatively.
Results and Discussion: A total of 20 studies were included in the final review. The evidence consistently demonstrated a strong, dose-dependent association between the number of prior cesarean sections and the risk of placenta accreta spectrum, particularly in the presence of placenta previa. Affected pregnancies were associated with high rates of severe hemorrhage, hysterectomy, intensive care admission, and increased healthcare resource utilization, despite advances in antenatal diagnosis and multidisciplinary management.
Conclusion: The findings confirm that rising cesarean section rates are a key driver of the increasing burden of placenta accreta spectrum disorders. Reducing unnecessary primary and repeat cesarean deliveries, improving antenatal risk stratification, and ensuring planned multidisciplinary care are essential strategies to mitigate maternal risk and optimize outcomes.
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References
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