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Contemporary Placenta Accreta Spectrum Disorder Incidence and Risk Factors
Alesha White1, Mishel Malik, Jessica E Pruszynski
1Department of Obstetrics and Gynecology and the Department of Radiology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas.
Obstetrics and Gynecology
|April 17, 2025
Summary
Maternal morbidity and placenta accreta spectrum (PAS) rates increase with each cesarean delivery. Placental location, particularly anterior placenta previa, significantly elevates PAS risk, highlighting the need for careful management.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Outcomes Research
Background:
- Cesarean delivery rates have steadily increased globally.
- Previous cesarean deliveries are a known risk factor for placenta accreta spectrum (PAS).
- Understanding contemporary morbidity rates associated with cesarean history and placental location is crucial for patient care.
Purpose of the Study:
- To determine current rates of maternal morbidity and PAS.
- To analyze the impact of prior cesarean delivery history on these rates.
- To investigate the influence of placental location on PAS risk.
Main Methods:
- Retrospective cohort study of 44,608 cesarean deliveries (January 2011 - May 2024).
- Comparison of maternal demographics, morbidities (PAS, hysterectomy, transfusion), and operative times based on the number of prior cesarean deliveries.
- Analysis of placental location (placenta previa, low-lying placenta) and its association with PAS and hysterectomy risk.
Main Results:
- Maternal morbidity, including PAS (0.03% to 2.8%) and hysterectomy (0.5% to 4.2%), significantly increased with the number of cesarean deliveries (P <.001).
- Anterior placenta previa and low-lying placentas showed markedly elevated PAS rates, especially with multiple prior cesareans.
- Increased cesarean history and anterior placental location in the lower uterine segment were associated with significantly higher odds ratios for PAS and hysterectomy.
Conclusions:
- Maternal morbidity escalates with successive cesarean deliveries, driven by increased abnormal placentation and adhesive disease.
- Placental location, particularly anterior placenta previa or low-lying placenta, is a critical determinant of PAS risk.
- These findings underscore the importance of considering both cesarean history and placental position in assessing and managing PAS risk.
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