Abstract:Objective: To investigate the prenatal diagnosis, clinical features and perinatal outcomes of placenta accreta spectrum (PAS) in different positions of the placenta. Methods: All pregnant women who delivered at Ｔhe First Affiliated Hospital of Chongqing Medical University from January 2012 to December 2021 and were finally diagnosed with PAS were included. They were divided into three groups depending on the placenta location (anterior, posterior, lateral/uterine fundus). Prenatal diagnosis rate, clinical features and perinatal outcomes among the three groups were compared. Results: A total of 2 070 pregnant women were included. In terms of basic characteristics, gravidity, parity, placenta previa rate, cesarean section times≥2 and previous history of placenta previa was significantly higher in the anterior placenta group (P<0.05). The placental accreta rate, multiple pregnancy, in vitro fertilization, vaginal delivery rate and delivery gestational age in the posterior group were higher than those in the anterior placenta group (P<0.05). In terms of grade of PAS and prenatal diagnosis rate, the incidence of placental increta and percreta in anterior wall was significantly higher than that in posterior wall, and the overall prenatal diagnosis rate of PAS was significantly higher than the other two groups (P<0.05) ; further comparison showed that the prenatal diagnosis rate of placental accreta in anterior wall was significantly higher than the other two groups (P<0.05) , and the diagnosis rate of placental increta in anterior wall was also higher than posterior wall (P<0.05) , and there was no statistically significant difference among the three groups in comparison of placenta percreta. Compared with the preoperative procedure, the abdominal aortic balloon, uterine packing, uterine binding, hysterectomy, and postoperative uterine artery embolization were higher in anterior placenta group (P<0.05). In terms of perinatal outcomes, 24 hours blood loss, transfusion of blood products, other organ damage, transfer to intensive care unit (ICU) and postoperative hospital stay were significantly higher in the anterior placenta group (P<0.05). The mean birth weight of neonates in the posterior placenta group was higher than that in the anterior placenta group (P<0.05). Conclusion: The prenatal diagnosis rate of PAS in non-anterior placenta is low, but the rate of severe placenta accreta is higher in anterior placenta, and perinatal outcomes is much worse in anterior placenta. On the one hand, it is necessary to be more vigilant about the occurrence of PAS in posterior placenta, and if necessary, further diagnosis can be made by magnetic resonance imaging (MRI). On the other hand, active multidisciplinary management of pregnant women with prenatal diagnosis of PAS is necessary to improve the perinatal outcomes of these women.
