Risk Factors, Ultrasonographic-Histopathological Comparison, and Maternal Outcomes of the Placenta Accreta Spectrum: An Ambispective Cohort Study From a Tertiary Care Hospital in Northern India.

AIM: Placenta accreta spectrum (PAS) is one of the leading causes of severe obstetric haemorrhage and peripartum hysterectomy, with a rising incidence due to increasing caesarean delivery rates worldwide. This study aimed to evaluate the risk factors for PAS, assess the concordance between ultrasonographic and histopathological findings, and determine maternal outcomes at a tertiary referral centre in northern India.

METHODS

An ambispective observational study was conducted in the Department of Obstetrics and Gynaecology, Upper India Sugar Exchange Maternity Hospital, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India, between January 2020 and July 2024. Retrospective data (January 2020-December 2021) and prospective enrolment (January 2022-July 2024) were included in the study. Women with an antenatal or intraoperative diagnosis of PAS were included. Maternal demographics, obstetric history, intraoperative findings, transfusion requirements, intensive care admission, and maternal morbidity and mortality were recorded.

RESULTS

Seventy women with PAS were identified during the 4.5-year study period. The institutional burden of PAS among women screened based on predefined risk factors increased from 20/720 (2.8%) in the retrospective period to 50/720 (6.9%) during the prospective period, with an overall burden of 70/1,440 (4.9%). Prior caesarean delivery was the dominant associated risk factor (62/70, 88.6%), with two prior caesarean deliveries in 28/70 cases (40.0%). Low-lying placenta was present in 20/70 women (28.6%), while placenta previa coexisted in 26/70 women (37.1%), giving a combined prevalence of 46/70 (65.7%). Caesarean hysterectomy was required in 58/70 women (82.85%), with a mean estimated blood loss of 1854.3 ± 417.3 mL and substantial perioperative transfusion requirements. One maternal death (1/70,1.43%) occurred; 9/70 (12.9%) women required intensive care. Histopathology confirmed all PAS cases (70/70,100%) and served as the reference standard. Ultrasonography correctly identified all cases of placenta increta (17/17, 100%) and placenta percreta (9/9, 100%) but detected only 26/44(59.1%) cases of placenta accreta.

CONCLUSION

Prior caesarean delivery and coexisting placenta previa were the principal risk factors in this cohort. The rising institutional burden of PAS highlighted the need for early antenatal diagnosis, structured referral pathways, and multidisciplinary perioperative care in tertiary centres.