Increased level of cell‐free placental mRNA in a subgroup of placenta previa that needs hysterectomy

Objective The purpose of this study was to investigate whether cell‐free placental mRNA levels have the potential to predict a placenta previa resulting in hysterectomy. Methods Twenty‐eight singleton pregnant women with placenta previa were classified into the following four groups: 16 women with placenta located at a posterior part of the uterine wall (Group A); 4 each with placenta located at the anterior wall without (Group B) or with (Group C) previous cesarean section; and the other 4 with a history of previous cesarean section and who had the placenta located at an anterior part of uterine wall and underwent a cesarean hysterectomy (Group D). The maternal plasma concentrations of the cell‐free placental lactogen (PL) mRNA measured by real‐time reverse‐transcription polymerase chain reaction (PCR) were converted into multiples of the median (MoM). Results The MoM (range) values of cell‐free PL mRNA in the control group and Groups A to D were 1.00 (0.39–2.35), 2.04 (0.91–3.93), 2.58 (1.90–3.90), 3.50 (1.20–4.30), and 6.28 (5.24–7.63), respectively. The concentration of cell‐free PL mRNA was significantly higher in Group D than in Group A, B, or C (Mann–Whitney's U ‐test, P < 0.05). Conclusion The cell‐free PL mRNA concentration in maternal plasma has the potential to predict a subgroup of placenta accreta resulting in hysterectomy. Copyright © 2008 John Wiley & Sons, Ltd.