BMC Pregnancy Childbirth. 2026 May 15. doi: 10.1186/s12884-026-09214-x. Online ahead of print.
ABSTRACT
BACKGROUND: Placenta accreta spectrum (PAS) is a severe obstetric condition associated with substantial maternal and neonatal morbidity. This study aimed to evaluate a five-year experience of PAS management in a tertiary referral center and compare outcomes with those from a preceding five-year period.
METHOD: this retrospective cohort study was conducted at hospitals affiliated with Shiraz University of Medical Sciences, a tertiary referral center in southern Iran. Pregnant women diagnosed with PAS between January 2020 and December 2024, compared with a historical cohort from January 2015 to December 2019. Clinical and operative data of PAS cases were reviewed. Maternal morbidity and mortality were defined as primary outcomes, while operative characteristics, intraoperative complications, and neonatal outcomes were secondary outcomes. Statistical analyses were performed using SPSS software, with Mann-Whitney and Chi-square tests applied for inter-period comparisons. Maternal morbidity and mortality, operative blood loss, intraoperative complications, gestational age at diagnosis and delivery, and neonatal outcomes were assessed.
RESULTS: Of 325 PAS cases, 300 women underwent hysterectomy and were included in the analysis. The mean gestational age at operation was 31.16 ± 6.16 weeks, and 97% had a prior cesarean section. PAS was diagnosed before 14 weeks in 5%, between 14 and 28 weeks in 41%, and after 28 weeks in 54% of cases. Emergency surgery was required in 18.3%. Mean intraoperative blood loss was 2119.76 ± 1612.93 mL and was significantly higher in placenta percreta (p < 0.001). Bladder injury occurred in 23%, and 79% required packed cell transfusion. Neonatal survival was 83.7%, with 74.7% admitted to the NICU. Compared with the earlier cohort, gestational age at diagnosis was significantly earlier, hospital stay was shorter, and fifth-minute Apgar scores were higher (all p < 0.001).
CONCLUSIONS: Enhanced prenatal diagnosis and multidisciplinary management have improved maternal and neonatal outcomes in PAS over recent years.
PMID:42141408 | DOI:10.1186/s12884-026-09214-x
