Clinical and anamnestic features of patients with placenta accreta: analysis of risk factors and obstetric outcomes

• Victor E. Radzinsky
• Vladislav B. Zubenko
• Roman E. Orekhov

Abstract

Placenta accreta spectrum (PAS) is a serious obstetric problem associated with high risks of maternal morbidity and mortality. The incidence of PAS is increasing worldwide, linked to the rising rates of cesarean sections and advancing maternal age. Despite previously identified risk factors, their interactions and impact on obstetric outcomes remain insufficiently studied. This research aims to analyze the clinical and anamnestic features of patients with PAS, identify key risk factors, and evaluate their influence on obstetric outcomes to improve early diagnosis and management strategies for this condition.

Aim. To identify clinical and anamnestic features and risk factors for placenta accreta in pregnant women with and without placenta previa.

Material and methods. The study included 246 patients with placenta previa (ICD-10: O44 Placenta previa) and/or placenta accreta (ICD-10: O43.2 Placenta accreta). Participants’ ages ranged from 18 to 46 years, with a median age of 34 years (Q₁–Q₃: 30–37). Primary medical records were analyzed with elements of expert review. Patients were divided into three groups: placenta previa without accreta (n=132), placenta previa with accreta (n=104), and placenta accreta without previa (n=10). Statistical analysis included calculating odds ratios (OR) with 95% confidence intervals (CI), and using Mann–Whitney, Kruskal–Wallis, and Pearson’s chi-square tests for group comparisons.

Results. Established risk factors for placenta accreta include: placenta previa after cesarean section (OR 4.425; 95% CI 2.571–7.576), anterior placental location (OR 4.235; 95% CI: 2.439–7.353), thyroid diseases (OR 2.531; 95% CI 1.041–6.173), antiphospholipid syndrome (OR 2.527; 95% CI 1.195–5.348), hyperemesis gravidarum (OR 2.440; 95% CI 1.085–5.495), and hospitalizations during pregnancy with placenta previa (OR 1.948; 95% CI 1.141–3.322).

Conclusion. The risk factors for placenta accreta identified in this study emphasize the need for a comprehensive approach to risk assessment in pregnant women, which may contribute to early diagnosis and improved management strategies for patients at high risk of placenta accreta, potentially reducing associated maternal morbidity and mortality.

Keywords: placenta accreta; risk factors; placenta previa; obstetric outcomes

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