Placenta accreta spectrum: A multidisciplinary approach for identifying risk factors and for better fetomaternal outcomes – A retrospective study.
DOI:
https://doi.org/10.51168/rvrjc379Keywords:
High-Risk Pregnancy, Neonatal Outcome, Maternal Morbidity, Peripartum Hysterectomy, Obstetric Hemorrhage, Multidisciplinary Management, Previous Cesarean Section, Placenta Previa, Placenta Percreta, Placenta Increta, Placenta Accreta, Placenta Accreta SpectrumAbstract
Background
Aim: To identify the risk factors associated with Placenta Accreta Spectrum and to evaluate fetomaternal outcomes following multidisciplinary management in a tertiary care center.
Materials and methods
Antenatal PAS cases handled at Jubilee Mission Medical College, Kerala, between January 2020 and May 2026 were studied retrospectively in a cross-sectional analysis. Descriptive analysis was carried out for maternal, obstetric, diagnostic, operative, transfusion, complication, multidisciplinary, critical care, and fetal outcomes.
Results
The study included women diagnosed with Placenta Accreta Spectrum, the majority of whom had a history of previous cesarean delivery. Most patients were diagnosed antenatally through ultrasonography, while magnetic resonance imaging was utilized in selected cases with diagnostic uncertainty. Placenta accreta constituted the most common subtype, followed by placenta increta and placenta percreta. Placenta previa was frequently associated with abnormal placentation. Multidisciplinary management involved coordinated participation of obstetricians, anesthesiologists, radiologists, intensivists, neonatologists, urologists, surgeons, and transfusion medicine specialists.
Hysterectomy represented the predominant management strategy, whereas conservative uterine-preserving procedures were performed in selected patients. Maternal morbidity was primarily related to postpartum hemorrhage, multiple blood transfusions, disseminated intravascular coagulation, bladder injury, hemorrhagic shock, and intensive care admission. Significant utilization of packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate reflected the substantial hemorrhagic burden associated with PAS. Neonatal outcomes were mainly influenced by prematurity, low birth weight, and neonatal intensive care admission. Multidisciplinary management enhanced fetomaternal outcomes regardless of significant morbidity.
Conclusion
PAS, a serious obstetric complication related to prior caesarean delivery and placenta previa, poses a risk to the mother and fetus. The earlier the diagnosis and proper surgery planning with availability of blood products are vital for improving results in tertiary hospitals.
Recommendation
Women with previous cesarean sections and placenta previa should undergo targeted antenatal screening for Placenta Accreta Spectrum.
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Copyright (c) 2026 Dr. Kanjoor Deepthi Damodaran Nair, Dr. Briji S Panicker, Dr. Ajeena P. S
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