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.