Women who give birth by vaginal or C-section deliveries can retain the placenta. They can also fall in the placenta accreta spectrum or PAS. The presence of placenta praevia and a prior cesarean also influence the pregnancy outcomes. This study assesses the PAS clinical profiles to improve the health of both the mother and the infant.

A population-based prospective study was designed for 176 maternity hospitals in 8 French regions. It sourced 249 PAS women from a total of 520,114 deliveries. They were classified into two risk profile groups for description and comparison. The first group had a high-risk combination of placenta praevia or anterior low-lying placenta and a minimum of one prior caesarian. The second group did not have both these factors. The pregnancies, PAS incidences, deliveries, women’s traits, and pregnancy outcomes were measured.

The PAS incidence was 4.8/10000 with 95% CI (4.2+5.4)/2. Some women did not follow-up, and the first group had 115 or 48% women with both factors. The second group without the combination had 127 or 52% women. The first group’s antenatal PAS, percreta, and hysterectomies were high at 77%, 38%, and 53%. The same parameters for the second group were at 17%, 5%, and 21%. Maternal complications, preterm births, neonatal ICU admissions, and blood transfusions in the first group were also higher. Sensitivity analysis results were similar after excluding vaginal births.

Half the women had PAS without placenta praevia and a prior C-section. Their maternal and neonatal outcomes were also positive. One cannot rule out placenta retention vs. PAS in vaginal and cesarean deliveries either.

Ref: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.16647