Comparison of Occurrence of Placenta Accreta Spectrum in Patients with Previously Operated Elective versus Emergency Lower Segment Caesarean Section: An Analytical Cross-Sectional Study: Placenta Accreta Spectrum with Operated Elective versus Emergency LSCS

Farzana Sadiq; Shazia Naseeb

doi:10.54393/pjhs.v7i9.4364

Authors

Farzana Sadiq Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Shazia Naseeb Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i9.4364

Keywords:

Elective Surgical Procedures, Placenta Accreta Spectrum, Caesarean Section, Emergency Treatment, Pregnancy Complications

Abstract

Placenta accreta spectrum (PAS) is a serious obstetric condition characterised by abnormal placental invasion into the uterine wall, leading to severe maternal complications such as massive haemorrhage and hysterectomy. The rising rate of caesarean section has increased the burden of PAS worldwide. Objective: To compare the occurrence of PAS in women with a history of elective versus emergency lower segment caesarean section (LSCS). Methods: This analytical cross-sectional study enrolled 105 women at Jinnah Postgraduate Medical Centre, Karachi, from March to September 2025. Women aged 25–45 years with parity >1, gestation >24 weeks, and a previous caesarean section were recruited by non-probability consecutive sampling and grouped by the mode of the previous LSCS (elective or emergency) as the two primary comparison groups. PAS occurrence was compared between the groups using the chi-square or Fisher’s exact test (p≤0.05). Results: Of 105 women, 24 had a previous elective and 81 a previous emergency LSCS. PAS occurred in 23 of 24 (95.8%) elective versus 70 of 81 (86.4%) emergency cases, a non-significant difference (Fisher’s exact p=0.289). Overall PAS frequency was 88.6%, with percreta predominating (42.9%). Mean maternal age was significantly higher among women with PAS (32.83 ± 3.97 vs 29.19 ± 4.93 years; p=0.001). Conclusions: PAS occurred with high frequency after prior caesarean section, with no significant difference between elective and emergency LSCS. As the study was underpowered for this comparison, the finding is hypothesis-generating; advanced maternal age was significantly associated with PAS, underscoring the primacy of uterine scar burden.

References

Hobson SR, Kingdom JC, Murji A, Windrim RC, Carvalho JC, Singh SS et al. No. 383-Screening, Diagnosis, and Management of Placenta Accreta Spectrum Disorders. Journal of Obstetrics and Gynecology Canada. 2019 Jul; 41(7): 1035-49. doi: 10.1016/j.jogc.2018.12.004. DOI: https://doi.org/10.1016/j.jogc.2018.12.004

Jauniaux ER, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. International Journal of Obstetrics & Gynecology. 2018 Dec; 126(1): e1-48. doi: 10.1111/1471-0528.15306. DOI: https://doi.org/10.1111/1471-0528.15306

Matsuzaki S, Mandelbaum RS, Sangara RN, McCarthy LE, Vestal NL, Klar M et al. Trends, Characteristics, and Outcomes of Placenta Accreta Spectrum: A National Study in the United States. American Journal of Obstetrics and Gynecology. 2021 Nov; 225(5): 534-e1. doi: 10.1016/j.ajog.2021.04.233. DOI: https://doi.org/10.1016/j.ajog.2021.04.233

Boerma T, Ronsmans C, Melesse DY, Barros AJ, Barros FC, Juan L et al. Global Epidemiology of Use of and Disparities in Caesarean Sections. The Lancet. 2018 Oct; 392(10155): 1341-8. doi: 10.1016/S0140-6736(18)31928-7. DOI: https://doi.org/10.1016/S0140-6736(18)31928-7

Ogawa K, Jwa SC, Morisaki N, Sago H. Risk Factors and Clinical Outcomes for Placenta Accreta Spectrum with or Without Placenta Previa. Archives of Gynecology and Obstetrics. 2022 Mar; 305(3): 607-15. doi: 10.1007/s00404-021-06189-2. DOI: https://doi.org/10.1007/s00404-021-06189-2

Iacovelli A, Liberati M, Khalil A, Timor-Trisch I, Leombroni M, Buca D et al. Risk Factors for Abnormally Invasive Placenta: A Systematic Review and Meta-Analysis. The Journal of Maternal-Fetal and Neonatal Medicine. 2020 Feb; 33(3): 471-81. doi: 10.1080/14767058.2018.1493453. DOI: https://doi.org/10.1080/14767058.2018.1493453

Birendra R and Jigyasa S. A Retrospective Study of Maternal and Neonatal Outcome in Placenta Accreta Spectrum After Planned or Emergency Delivery from a Tertiary Care Centre in North India. Cureus. 2023 Sep; 15(9). doi: 10.7759/cureus.44725. DOI: https://doi.org/10.7759/cureus.44725

Coutinho CM, Giorgione V, Noel L, Liu B, Chandraharan E, Pryce J et al. Effectiveness of Contingent Screening for Placenta Accreta Spectrum Disorders Based on Persistent Low‐Lying Placenta and Previous Uterine Surgery. Ultrasound in Obstetrics and Gynecology. 2021 Jan; 57(1): 91-6. doi: 10.1002/uog.23100. DOI: https://doi.org/10.1002/uog.23100

AlQasem MH, Shaamash AH, Al Ghamdi DS, Mahfouz AA, Eskandar MA. Incidence, Risk Factors, and Maternal Outcomes of Major Degree Placenta Previa: A 10-Year Retrospective Analysis. Saudi Medical Journal. 2023 Sep; 44(9): 912. doi: 10.15537/smj.2023.44.9.20230112. DOI: https://doi.org/10.15537/smj.2023.44.9.20230112

Hessami K, Salmanian B, Einerson BD, Carusi DA, Shamshirsaz AA, Shainker SA et al. Clinical Correlates of Placenta Accreta Spectrum Disorder Depending on the Presence or Absence of Placenta Previa: A Systematic Review and Meta-Analysis. Obstetrics and Gynecology. 2022 Oct; 140(4): 599-606. doi: 10.1097/AOG.0000000000004923. DOI: https://doi.org/10.1097/AOG.0000000000004923

Wang Y, Zeng L, Niu Z, Chong Y, Zhang A, Mol B et al. An Observation Study of the Emergency Intervention in Placenta Accreta Spectrum. Archives of Gynecology and Obstetrics. 2019 Jun; 299(6): 1579-86. doi: 10.1007/s00404-019-05136-6. DOI: https://doi.org/10.1007/s00404-019-05136-6

Opiyo N, Bellizzi S, Torloni MR, Souza JP, Betran AP. Association Between Prelabour Caesarean Section and Perinatal Outcomes: Analysis of Demographic and Health Surveys from 26 Low-Income and Middle-Income Countries. British Medical Journal Open. 2022 Jan; 12(1): e053049. doi: 10.1136/bmjopen-2021-053049. DOI: https://doi.org/10.1136/bmjopen-2021-053049

Etcheverry C, Betrán AP, de Loenzien M, Robson M, Kaboré C, Lumbiganon P et al. How Does Hospital Organization Influence the Use of Caesarean Sections in Low- and Middle-Income Countries? A Cross-Sectional Survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC Project. BioMed Central Pregnancy and Childbirth. 2024 Jan; 24(1): 67. doi: 10.1186/s12884-024-06257-w. DOI: https://doi.org/10.1186/s12884-024-06257-w

Thang NM, Anh NT, Thanh PH, Linh PT, Cuong TD. Emergent versus Planned Delivery in Patients with Placenta Accreta Spectrum Disorders: A Retrospective Study. Medicine. 2021 Dec; 100(51): e28353. doi: 10.1097/MD.0000000000028353. DOI: https://doi.org/10.1097/MD.0000000000028353

Alavi SM, Arjmandnia MH, Feizollahjani M, Noori E, Yousefi M. Placenta Accreta Spectrum; Risk Factors, Complications, Advantages and Disadvantages to Decrease Maternal Morbidity and Mortality. Journal of Obstetrics, Gynecology and Cancer Research. 2024 Aug; 9(5): 516-21. doi: 10.30699/jogcr.9.5.516. DOI: https://doi.org/10.30699/jogcr.9.5.516

Jauniaux E and Ayres-de-Campos D. FIGO Consensus Guidelines on Placenta Accreta Spectrum Disorders: Introduction. International Journal of Gynecology and Obstetrics. 2018; 140(3): 261-4. doi: 10.1002/ijgo.12406. DOI: https://doi.org/10.1002/ijgo.12406

Donovan BM and Shainker SA. Placenta Accreta Spectrum. Neoreviews. 2021 Nov; 22(11): e722-33. doi: 10.1542/neo.22-11-e722. DOI: https://doi.org/10.1542/neo.22-11-e722

Abinader RR, Macdisi N, El Moudden I, Abuhamad A. First‐Trimester Ultrasound Diagnostic Features of Placenta Accreta Spectrum in Low‐Implantation Pregnancy. Ultrasound in Obstetrics and Gynecology. 2022 Apr; 59(4): 457-64. doi: 10.1002/uog.24828. DOI: https://doi.org/10.1002/uog.24828

Sugai S, Yamawaki K, Sekizuka T, Haino K, Yoshihara K, Nishijima K. Pathologically Diagnosed Placenta Accreta Spectrum Without Placenta Previa: A Systematic Review and Meta-Analysis. American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine. 2023 Aug; 5(8): 101027. doi: 10.1016/j.ajogmf.2023.101027. DOI: https://doi.org/10.1016/j.ajogmf.2023.101027

Matsuzaki S, Rau AR, Mandelbaum RS, Tavakoli A, Mazza GR, Ouzounian JG et al. Assessment of Placenta Accreta Spectrum at Vaginal Birth After Cesarean Delivery. American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine. 2023 Oct; 5(10): 101115. doi: 10.1016/j.ajogmf.2023.101115. DOI: https://doi.org/10.1016/j.ajogmf.2023.101115

Rau AR, Youssefzadeh AC, Matsuzaki S, Mandelbaum RS, Ouzounian JG, Matsuo K. Unsuspected Placenta Accreta Spectrum at Vaginal Delivery: Assessment of Incidence, Characteristics, and Maternal Morbidity. American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine. 2023 May; 5(5): 100805. doi: 10.1016/j.ajogmf.2022.100805. DOI: https://doi.org/10.1016/j.ajogmf.2022.100805

Patel-Lippmann KK, Planz VB, Phillips CH, Ohlendorf JM, Zuckerwise LC, Moshiri M. Placenta Accreta Spectrum Disorders: Update and Pictorial Review of the SAR-ESUR Joint Consensus Statement for MRI. Radiographics. 2023 Apr; 43(5): e220090. doi: 10.1148/rg.220090. DOI: https://doi.org/10.1148/rg.220090

Einerson BD, Sandlin AT, Afshar Y, Sharawi N, Fox KA, Newton JM et al. General Management Considerations for Placenta Accreta Spectrum. American Journal of Perinatology. 2023 Jul; 40(09): 1026-32. doi: 10.1055/s-0043-1761915. DOI: https://doi.org/10.1055/s-0043-1761915