Placenta Previa with Placenta Accreta Spectrum: Prenatal Risk Factors and the Maternal–Perinatal Morbidity

Abstract

Background:
Placenta previa is associated with life-threatening obstetric hemorrhage, frequently necessitating emergency surgical intervention and massive blood transfusion.
Objectives: To evaluate the spectrum of maternal morbidity, intraoperative blood loss volume, and perinatal outcomes in women diagnosed with placenta previa.
Materials and methods: We conducted a retrospective study of 120 pregnant women with placenta previa (complete previa: n = 52; partial previa: n = 68). The incidence of placenta accreta spectrum (PAS), massive hemorrhage (> 1000 mL), emergency hysterectomy, and neonatal outcomes were analyzed.
Results: Mean intraoperative blood loss was 1150 ± 420 mL. Massive hemorrhage occurred in 34.2% (n = 41) of women, and blood transfusion was required in 38.3% (n = 46). PAS was confirmed in 14 (11.7%) patients; emergency hysterectomy was required in 8 (6.7%) cases. The primary risk factor for PAS was a prior cesarean uterine scar (OR = 6.82; 95% CI: 2.15–21.64; p = 0.001). Preterm delivery (< 37 weeks) occurred in 58.3% of cases. Neonatal morbidity was primarily driven by respiratory distress syndrome (32.5%) and low birth weight (41.7%).
Conclusions: A prior uterine scar in the presence of placenta previa dramatically increases the risk of placental accreta spectrum and massive hemorrhage, highlighting the necessity of preoperative MRI mapping and surgical preparedness for organ-preserving hemostasis.

Keywords:
Placenta previa; placenta accreta spectrum; obstetric hemorrhage; cesarean section; hysterectomy.