Diagnostic Value of Uric Acid/Albumin Ratio and Platelet Indices in Predicting Hypervascularization in the Placenta...

Objective: This study evaluated the association of the uric acid/albumin ratio (UAR) and platelet indices-mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR)-in predicting hypervascularization in placenta accreta spectrum (PAS) and compared clinical and perinatal characteristics among PAS, placenta previa, and healthy pregnancies. Methods: This retrospective study included 229 pregnant women managed and delivered at a tertiary hospital (PAS, n = 76; previa, n = 77; healthy controls, n = 76) between January 2023 and January 2025. Hypervascularization was staged using the ultrasonographic PAS scoring system: PAS0 (placenta previa without hypervascularization), PAS1 (abnormal placental findings without hypervascularization), PAS2 (uterovesical hypervascularization), and PAS3 (extensive vascularity to the parametrial area). The final diagnosis and severity of PAS were confirmed intraoperatively according to the FIGO clinical classification criteria. Platelet indices and UAR were obtained from preoperative blood tests. Results: Compared with placenta previa (PAS0) and control groups, PAS1-3 cases had higher gravidity, parity, previous cesarean history, postpartum hemorrhage, hysterectomy, and transfusion rates (all p < 0.001). In the high hypervascularization subgroup (PAS2-3, n = 38), MPV (median 10.3 fL) and PDW (11.6%) were significantly lower than in low/absent hypervascularization cases (PAS0-1) (p = 0.001, p = 0.001, respectively). UAR showed no significant difference (p = 0.891). Conclusions: Lower MPV and PDW were associated with hypervascularization in PAS and may serve as non-invasive adjunctive markers for risk stratification. Their predictive performance was modest, and UAR had no diagnostic value, likely due to physiological changes in pregnancy. Further prospective, multicenter research is needed to validate these findings.