Assisted reproductive technologies and the risk of placenta accreta

Baranovskaya E.I.

doi:https://doi.org/10.17116/repro20243003143

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INTRODUCTION

The frequency of Placenta accreta spectrum (PAS) in pregnancy as a result of assisted reproductive technologies (ART) is 2.6—3.3% versus 0.05—0.84% of all births. PAS and retained products of conception following delivery in women with ART increases the frequency of blood transfusions.

OBJECTIVE

To investigate the relationship of placenta accreta spectrum with assisted reproductive technologies.

MATERIALS AND METHODS

The search was carried out in the PubMed/MEDLINE database between 2012 and 2022 and completed on 12/15/2022. For the query, the keywords «assistant reproductive technology, ART», «in vitro fertilization, IVF», «placenta accreta» were used.

RESULTS

ART is an independent predictor of placenta accreta spectrum (adjusted relative risk, aRR 2.00; 95% confidence interval, CI 1.96—2.04). Special technological procedures used in the ART protocol, such as cryopreservation of embryos, or transfer of an embryo into a uterus with a “thin” endometrium, are also risk factors for PAS. Obstetric predictors of PAS — previous caesarean section (CS), placenta previa, and both in patients undergoing ART are strong risk factors for PAS (aRR 5.34; 95% CI 3.70—7.71 for 1 CS; aRR 16.5; 95% CI 11.5—23.6 for 2 or more CSs). Advanced reproductive age and prior uterine interventions causing infertility (OR 5.80; 95% CI 2.49—13.50; p<.0001) are also associated with PAS. The influence of epigenetic causes due to the long stay of the embryo in an artificial environment, the cryopreservation procedure, needs to be studied.

CONCLUSIONS

ART in general is an independent predictor of placenta accreta spectrum. The immediate causes of placenta accreta can be both individual technological procedures of ART and uterine factor of infertility.

Keywords:

assisted reproductive technologies

in vitro fertilization

placenta accreta

Authors:

Baranovskaya E.I.

Belarusian State Medical University

ORCID: 0000-0002-2116-4675

Received:

06.03.2023

Accepted:

12.07.2023

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References:

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