Short inter pregnancy interval after CS does not affect incidence of placenta previa disorder
Interpregnancy interval (IPI) is defined as the time lapse between two consecutive pregnancies. It has also been defined as the time between the end of one pregnancy and the beginning of the next pregnancy. Normal IPI is defined as IPI between 18 and 36 months. Short IPI is defined as IPI less than 18 months.
An IPI less than 6 months is most often associated with adverse outcomes. Women who have short IPIs of less than 18 months have been linked with an increased risk of adverse perinatal outcomes, including placenta previa. However, there is paucity of data on the relationship between IPI and the risk of placenta previa and placenta accreta spectrum disorder in low-income settings where there are high aversions for cesarean section. The aim of the study by Uchenna Anthony Umeh and team was to determine and compare the incidence of placenta previa and the placenta accreta spectrum disorder following a previous cesarean section between women with short IPI and those with normal IPI.
A prospective cohort three-center study involving parturients who had previous cesarean section was conducted. Participants were included if pregnancy has lasted up to 34 weeks. Parturients with co-existing uterine fibroids, multiple gestations, premature rupture of membranes, and those with prior postcesarean delivery wound infection were excluded. The eligible women recruited were distributed into two groups, namely, short (<18 months) and normal (18–36 months) IPI. e outcome measures were incidences of placenta previa and placenta accreta spectrum disorder and factors associated with the occurrence of placenta previa. A univariate analysis was performed using the chi-square test or Mann–Whitney U test, wherever appropriate, to examine the signicance of the dierences in clinical variables.><18 months) and normal (18–36 months) IPI. The outcome measures were incidences of placenta previa and placenta accreta spectrum disorder and factors associated with the occurrence of placenta previa.
A total of 248 women met the inclusion criteria. The incidence of placenta previa by ultrasound was 8.9% and 4.0% for short and normal IPI (p= 0.13), respectively. The incidence of placenta accreta spectrum disorder was 1.6% and 0.8% for short and normal IPI (p = 0.57), respectively. The only observed significant difference between the clinical variables and placenta previa is the number of cesarean sections (p=0.02) in women with short IPI.
In this study, the incidence of placenta previa by ultrasound in women with short IPI was 8.9% and by inspection during delivery was 9.7%. Similarly, the prevalence of placenta previa by ultrasound in women with normal IPI was 4.0% and by inspection during delivery was 4.8%.
The results of the studies suggest that a short IPI may not increase the risk of developing placenta accreta spectrum disorder. The reasons for study findings were not very clear although it could be that the risk of placenta previa and placenta accreta spectrum disorder were similar irrespective of the IPI or that the higher prevalence of placenta previa or placenta accreta spectrum disorder in people with short IPI may be explained by other factors other than the interval between the pregnancies.
Short interpregnancy interval appears not to significantly affect the incidence of placenta previa and placenta accreta spectrum disorder following a cesarean section. However, placenta previa and placenta accreta spectrum disorder occur more in women with a previous history of cesarean section and the chance of placenta previa also increases with successive increase in the number of cesarean sections. Health care providers should be trained in effective health education and counseling skills in order to impart knowledge to women on proper birth spacing and its benefits. Further research to re-evaluate the evidence-based findings of negative health consequences of short interpregnancy intervals among reproductive age women is recommended. There is a need for further study to corroborate our findings with that of others from low- and middle-income settings.
Source: Uchenna Anthony Umeh,George Uchenna Eleje , Justus Uchenna Onuh; Hindawi Obstetrics and Gynecology International Volume 2022, Article ID 8028639 https://doi.org/10.1155/2022/8028639
