First trimester hemorrhage and anemia: New insights into placenta accreta spectrum risk

A recent study led by researchers at Mount Sinai sheds light on a potential link between first-trimester hemorrhage, anemia, and placenta accreta spectrum (PAS) development. This research aims to refine risk stratification in obstetric care, potentially leading to earlier and more targeted surveillance for high-risk pregnancies.

"The motivation for this study was born out of a parental study that's currently unpublished, ongoing with our main goal of identifying non-traditional risk factors for PAS," said Henri M. Rosenberg, MD, a third-year fellow in maternal-fetal medicine at the Icahn School of Medicine at Mount Sinai in New York. "What the ultimate goal of being able at a preconception visit, or at a first OB, initial OB appointment, is being able to really scrutinize and risk stratify who needs more surveillance in this pregnancy."

The study’s findings revealed a significantly higher association between concurrent first-trimester hemorrhage and anemia with PAS. Rosenberg emphasized that while association does not imply causation, biological mechanisms could help explain the connection. "When we have hemorrhage and when we have anemia at a placental local level, there could be some local hypoxia going on, disruption of the placenta from the decidua. And in those cases, it's possible that at least so pro-inflammatory state, abnormal vascular remodeling of the arterials, and could ultimately lead to an abnormal attachment of the placenta to any prior uterine defect."

One of the most significant findings in the study was the strength of this association. "I don't think we expected to find the degree of association as high as it is, being 16 times higher for the development of PAS or diagnosis of PAS, if you have a concurrent hemorrhage and anemia," Rosenberg noted. "We think of all these traditional risk factors being prior C-sections, with or without prior previa, assisted reproductive technology, myomectomies, anything that can lead to uterine defect. But when we looked at when we compared our risk of association with the concurrent hemorrhage, it was much higher than these traditional risk factors."

Given these findings, Rosenberg reccomended heightened vigilance in obstetric care. "I think given these findings, any patient with a traditional risk factor, or non-traditional risk factors, as we're finding throughout our parent study and this secondary analysis, these patients should probably have earlier screening, possibly at a center that has experience looking and diagnosing placenta accreta spectrum."

Future research aims to further explore non-traditional risk factors and improve early diagnostic techniques. "It's important to continue to identify these non-traditional risk factors, to really risk stratify these patients and get them into earlier ultrasounds in the first trimester, possibly transvaginal if possible," Rosenberg concluded.