Abstract
This retrospective study investigated risk factors and clinical outcomes of placenta accreta in pregnancies complicated by pernicious placenta previa (PPP). A total of 177 women diagnosed with PPP and treated at our institution between July 2020 and July 2025 were included. Clinical, imaging, and perinatal data were retrieved and analyzed. Placenta accreta spectrum was diagnosed based on prenatal ultrasonography, magnetic resonance imaging, intraoperative findings, and histopathological confirmation. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Among all patients, 56 had placenta accreta and 121 did not. Women with accreta had higher rates of 2 or more prior cesarean sections, shorter intervals since the last cesarean, and anterior placental implantation (all P < .01). Imaging indicators, including loss of the retroplacental clear space on ultrasound and bladder wall interruption on magnetic resonance imaging, were also independently associated with accreta. Multivariate analysis identified 5 independent predictors: ≥2 previous cesarean sections (odds ratio [OR] = 5.31), shorter interpregnancy interval (OR = 0.62), anterior placental location (OR = 3.90), loss of retroplacental clear space (OR = 3.16), and bladder wall interruption (OR = 4.91). Maternal and neonatal outcomes worsened with increasing placenta accreta spectrum severity, characterized by greater intraoperative blood loss, higher transfusion and hysterectomy rates, earlier delivery, and lower neonatal birth weight and Apgar scores. Early identification of high-risk PPP patients using clinical and imaging markers, coupled with multidisciplinary management, is essential to improve maternal and neonatal outcomes.