Diagnostic and Prognostic Value of Platelet Indices in Placenta Accreta Spectrum

Placenta accreta spectrum (PAS) is a major obstetric emergency associated with massive hemorrhage, peripartum hysterectomy, and maternal morbidity. This study aimed to evaluate the diagnostic and prognostic value of platelet indices in PAS patients.

A retrospective study was conducted at Ankara Etlik City Hospital between August 2022 and August 2024. A total of 200 pregnant women were divided into three groups: PAS (n = 63), placenta previa (n = 67), and controls (n = 70). Maternal demographics, delivery outcomes, neonatal parameters, and laboratory results were analyzed. Platelet indices-platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (P-LCR)-were obtained from first trimester and preoperative blood counts. Receiver operating characteristic (ROC) analysis determined predictive cut-off values. Multivariate logistic regression was performed to identify independent predictors of hysterectomy.

First-trimester MPV < 10.45 demonstrated the highest discriminatory performance for predicting peripartum hysterectomy (AUC = 0.709, sensitivity 70.9%, specificity 71.4%). Third-trimester MPV, PDW, and P-LCR also showed moderate predictive value. First-trimester PDW > 12.75 predicted postpartum hemorrhage (AUC = 0.678), while PDW > 12.35 was associated with composite adverse neonatal outcomes (AUC = 0.597). In placenta previa patients, first-trimester PCT < 0.26 predicted PAS (AUC = 0.627). In multivariate analysis, only first-trimester MPV remained independently associated with hysterectomy (aOR 0.647, 95% CI 0.428-0.979; p = 0.040).

Platelet indices show statistically significant but moderate associations with adverse outcomes in PAS. First-trimester MPV may serve as an early adjunctive marker in high-risk pregnancies; however, these parameters should not replace imaging modalities and require validation in prospective multicenter studies.