• Heather J Baldwin, Jillian A Patterson, Tanya A Nippita, Siranda Torvaldsen, Ibinabo Ibiebele, Judy M Simpson, and Jane B Ford.
• Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St. Leonards, New South Wales, the Biostatistics Training Program, New South Wales Ministry of Health, North Sydney, Sydney Medical School Northern, University of Sydney, New South Wales, the Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St. Leonards, New South Wales, the School of Public Health and Community Medicine, UNSW Sydney, New South Wales, and the Sydney School of Public Health, University of Sydney, New South Wales, Australia.
• Obstet Gynecol. 2018 Feb 1; 131 (2): 227-233.

ObjectiveTo evaluate the association between prior invasive gynecologic procedures and the risk of subsequent abnormally invasive placenta (ie, placenta accreta, increta, and percreta).MethodsWe conducted a population-based data linkage study including all primiparous women who delivered in New South Wales, Australia, between 2003 and 2012. Data were obtained from linked birth and hospital admissions with a minimum lookback period of 2 years. Prior procedures invasive of the uterus were considered including gynecologic laparoscopy with instrumentation of the uterus; hysteroscopy, including operative hysteroscopy; curettage, including suction curettage and surgical termination; and endometrial ablation. Modified Poisson regression was used to determine the association between the number of prior gynecologic procedures and risk of abnormally invasive placenta.ResultsEight hundred fifty-four cases of abnormally invasive placenta were identified among 380,775 deliveries included in the study (22.4/10,000). In total, 33,296 primiparous women had at least one prior procedure (8.7%). Among women with abnormally invasive placenta, 152 (17.8%) had undergone at least one procedure compared with 33,144 (8.7%) among women without abnormally invasive placenta (P<.01). After adjustment, the relative risk was 1.5 for one procedure (99% CI 1.1-1.9), 2.7 for two procedures (99% CI 1.7-4.4), and 5.1 for three or more procedures (99% CI 2.7-9.6). Abnormally invasive placenta was also positively associated with maternal age, socioeconomic advantage, mother being Australia-born, placenta previa, hypertension, multiple births, use of assisted reproductive technology, and female fetal sex.ConclusionWomen with a history of prior invasive gynecologic procedures were more likely to develop abnormally invasive placenta. These insights may be used to inform management of pregnancies in women with a history of gynecologic procedures.

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