Clinical Characteristics and Outcomes of Patients with Suspected Placenta Accreta Spectrum: A Retrospective Study (2022–2023)

Abstract

Objectives: To describe the clinical characteristics, management strategies, and maternal and perinatal outcomes of patients
evaluated for suspected Placenta Accreta Spectrum (PAS).

Methods: This retrospective descriptive study included 175 pregnant women evaluated for suspected PAS at Dr. Moewardi
General Hospital between 2022 and 2023. The preoperative likelihood of PAS was assessed using the Morbidly Adherent
Placenta (MAP) score, whereas the final diagnosis was established according to the International Federation of Gynecology
and Obstetrics (FIGO) classification based on histopathological examination or intraoperative findings in patients managed
conservatively.

Results: Most patients had Class I obesity (40.0%), a history of fewer than two previous caesarean sections (78.9%), and
delivered at term (47.4%). Preoperative assessment showed that 52.6% of patients had low MAP scores, which was consistent
with the final FIGO classification, as 73.1% of patients were classified as FIGO Grade 0 (normal placentation or placenta previa
without invasion), indicating that true invasive PAS accounted for only a minority of cases. Consequently, conservative uterine
sparing management was feasible in most patients; 77.7% did not require hysterectomy, and 69.7% experienced an estimated
blood loss of less than 1,000 mL. Perinatal outcomes were generally favorable, with 58.3% of neonates having a normal birth
weight and 60.6% showing no signs of asphyxia.

Conclusion: Among patients evaluated for suspected PAS, the majority had low MAP scores and were ultimately classified as
FIGO Grade 0, indicating the absence of invasive placental disease. Consequently, conservative uterine-sparing management
was successfully implemented in most cases and was associated with favorable maternal and perinatal outcomes.

Keywords: cesarean section, maternal outcomes, perinatal outcomes, placenta accreta spectrum, uterine-sparing management