Frequency of the Placenta Accreta Spectrum (PAS) and its Comparison with Previous Scars and High-Order Scars: tertiary care referral hospital Punjab

Abstract

Placenta Accreta Spectrum is a major obstetric emergency that involves abnormal attachment of the placenta to the myometrium and is associated with high rates of maternal morbidity and mortality. The incidence is increasing worldwide along with the rise in caesarean sections. The aim of study is to assess the prevalence of PAS in women with a history of uterine scars and its impact with increasing number of previous caesarean sections including high-order scars, at a tertiary care hospital in Punjab.

Methods: A cross-sectional observational study was performed for three months in the Department of Obstetrics and Gynaecology. Consecutive sampling was employed to enrol 875 pregnant women aged between 18 and 40 years with gestational age ranging from 26 to 37 weeks and a history of at least one previous uterine scar. An expert radiologist scored the ultrasonographic findings using a specific scoring system, while histopathology findings were used as the gold standard for confirmation. The statistical analyses were conducted using SPSS version 27.0, and the chi-square test was used to assess associations. P-value of ≤0.05 was used for significance. Results: Histopathologically diagnosed PAS was observed in 265 women, giving a prevalence of 30.3%. The most frequent subtype was placenta accreta (53.6%) followed by increta (29.1%) and percreta (17.3%). The proportion of women with PAS increased from 19.1% in women with a single previous caesarean section to 42.7% with three or more uterine scars (χ² = 46.27, p < 0.001). Maternal age and high parity were also significant risk factors for PAS development (p < 0.01). Conclusion: PAS incidence rises with increasing number of previous caesarean sections, with greater risk associated with high-order caesarean scars. Prenatal risk assessment, optimization of indications for caesarean delivery..