Risk factors and maternal-neonatal outcomes of placenta accreta spectrum: A case control study

Placenta accreta spectrum (PAS) is a rare yet life-threatening obstetric complication. The primary risk factors include placenta previa and prior cesarean sections. However, high-quality epidemiological and clinical data on PAS remain scarce in China. This study aimed to comprehensively evaluate the clinical characteristics, pathological features, and radiological findings of PAS disorders in Chinese women, while quantifying the predictive value of key risk factors through receiver operating characteristic (ROC) curve analysis and assessing their impact on maternal-fetal outcomes. We conducted a retrospective study comparing clinicopathological and imaging data from 138 pathologically confirmed PAS patients and 276 age-matched controls at an academic women's hospital in China. Statistical analyses included χ2 tests, logistic regression, and ROC curve evaluation. Magnetic resonance imaging (MRI) demonstrated higher sensitivity than sonography for PAS detection (97.6% vs 68.8%, P < .05). Univariate analysis identified gravidity, parity, prior CS, abortion history, current multiple pregnancy, and placenta previa as significant risk factors (P < .01). Multivariate analysis confirmed multivariate analysis confirmed that increased gravidity, increased parity, current multiple pregnancy, and placenta previa are independent risk factors (P < .05). ROC curve analysis identified placenta previa as the strongest predictor (area under the curve (AUC) = 0.871), followed by increased gravidity (AUC = 0.732) and increased parity (AUC = 0.722). PAS patients had significantly higher rates of postpartum hemorrhage, CS and hysterectomy (P < .001), and adverse neonatal outcomes (perinatal mortality, congenital anomalies, preterm birth, low birth weight, and asphyxia; P < .05). Subgroup analysis revealed grade 3A PAS was most prevalent (89.9%), while grades 3D/3E (2.2% each) showed higher cesarean rates, hysterectomy, newborn asphyxia, and congenital anomalies. Grade 3A was associated with more postpartum hemorrhage and fetal mortality. This study confirms MRI's superior diagnostic accuracy for PAS (97.6% sensitivity). Placenta previa (AUC = 0.871) emerged as the strongest predictor, with increased gravidity and increased parity as key risk factors. PAS significantly increased maternal (89.9% hemorrhage rate) and neonatal complications, particularly in prevalent grade 3A cases, underscoring the need for early identification and multidisciplinary management in high-risk pregnancies.