PREVALENCE AND MANAGEMENT OF PLACENTA ACCRETA SPECTRUM DISORDERS

Abstract

Placenta accreta spectrum (PAS) refers to abnormal placental attachment (accreta, increta, percreta) that can lead to severe maternal morbidity and mortality, particularly in contexts with rising cesarean rates and limited antenatal diagnosis. Understanding its prevalence and management in a tertiary hospital such as Government Medical College (GMC) Kathua can help improve protocols and outcomes. Aim: To determine the prevalence, risk factors, clinical presentation, and management outcomes of PAS disorders among patients delivering at GMC Kathua. Methods: This was a hospital-based observational study conducted over one year. The sample included 100 patients diagnosed with PAS (either antenatally or intraoperatively) among all deliveries at GMC Kathua from January 2024 to December 2024. Data collected included socio-demographic details, obstetric history (parity, previous cesarean section, placenta previa, uterine surgery), clinical features, antenatal diagnostic tools used, management strategies (conservative vs non-conservative), maternal and neonatal outcomes. Statistical analyses included descriptive statistics and comparison of outcomes between antenatally diagnosed vs unexpected PAS, and between conservative vs hysterectomy management. Results: Prevalence of PAS was 2.5% among all deliveries (100/4000). Among PAS cases, 60% were placenta accreta, 25% increta, 15% percreta. Major risk factors: previous 1+ cesarean section (80%), placenta previa (45%), advanced maternal age >35 (30%), multiparity. Antenatal diagnosis achieved in 55 cases; those had lower blood loss (mean 1500 ml vs 2800 ml), fewer ICU admissions, lower rate of hysterectomy (60% vs 90%) compared to unexpected cases. Maternal morbidity included hemorrhage, transfusion (mean 3.5 units), bladder injury (10%), maternal mortality 1%. Neonatal outcomes: preterm delivery in 70%, NICU admission in 40%, perinatal mortality 5%. Conclusion: PAS is an increasing problem, with high morbidity. Early (antenatal) diagnosis and multidisciplinary management reduce adverse outcomes. At GMC Kathua, strengthening antenatal screening (ultrasound/MRI), preparedness for hemorrhage, and protocolized management may improve both maternal and neonatal outcomes.