Placenta Accreta Spectrum Disorders: Clinical Characteristics and Hemorrhagic Outcomes at Dr. Saiful Anwar General Hospital (2021-2025)

Abstract

Introduction: Placenta Accreta Spectrum (PAS) disorders, characterized by abnormal placental attachment to the uterine wall, pose challenges because of hemorrhagic complications. This study evaluated PAS cases at Dr. Saiful Anwar General Hospital, Malang, examining maternal risk factors and hemorrhagic outcomes.

Material and Methods: This retrospective descriptive study included pregnant women with suspected PAS who underwent delivery or surgery from July 2021 to June 2025. Data were obtained from medical records and hospital systems. Variables included characteristics, previous cesarean delivery, placenta previa, comorbidities, prenatal PAS suspicion, estimated blood loss, hysterectomy, transfusion, ICU admission, surgical complications, bladder injury, DIC, and neonatal outcomes. Data were analyzed using frequencies and percentages.

Results: Among 176 patients, 96.0% were multiparous, 77.8% had previous cesarean delivery, and 88.1% had placenta previa. Gestational age 37–38 weeks predominated (50.6%), as was maternal age 30–34 years (36.4%). Estimated blood loss of 1,000–5,000 mL occurred most frequently (46.0%). Hysterectomy was performed in 75.0%, 81.3% required transfusion, 17.6% required ICU admission, 21.6% experienced surgical complications, 10.2% had bladder injury, and 5.1% developed DIC. Maternal mortality was 1.1%. Live birth occurred in 95.0% of neonates, and 23.9% required NICU admission.

Conclusion: Advanced maternal age, cesarean history, and placenta previa were significantly associated with hemorrhagic risk. PAS was strongly linked to multiparity, previous cesarean delivery, and placenta previa, with hemorrhagic morbidity. Early recognition, multidisciplinary planning, and preparation for hemorrhage and surgical complications are essential. Further analytical studies are needed to identify factors associated with severe maternal and neonatal outcomes.