Placenta accreta spectrum outcomes represent a significant challenge in modern obstetric care. As caesarean section rates continue to climb globally, clinicians increasingly encounter complex placental attachment issues. A recent study investigated the link between previous caesarean sections (CS) and adverse pregnancy results. Specifically, researchers aimed to quantify how placenta previa (PP) mediates these risks within the PAS population.

Understanding Placenta Accreta Spectrum Outcomes

The researchers evaluated 231 patients, including those with no prior CS, one CS, and two or more CS procedures. Women with a history of two or more caesarean sections experienced higher rates of invasive PAS. Furthermore, they faced increased risks of massive intraoperative haemorrhage. Moreover, these patients required more frequent blood transfusions compared to those with fewer surgical histories. Consequently, the study emphasizes that a higher number of prior CS procedures independently predicts increased maternal morbidity. In India, where National Family Health Survey-5 data shows rising CS rates, these findings are particularly pertinent for obstetric planning.

The Mediating Influence of Placenta Previa

A key finding involved the role of placenta previa as a mediator. Notably, while PP is a known risk factor for PAS, it only partially explains the association with adverse outcomes. For instance, PP accounted for approximately 8.62% of the link between CS history and invasive PAS. It also contributed to 32.83% of the risk for preterm birth. However, neonatal outcomes appeared less affected by the number of prior surgeries. These results were more closely linked to the gestational age at delivery. Therefore, while PP is a critical pathway, other factors like uterine scarring also drive the severity of placenta accreta spectrum outcomes.

Frequently Asked Questions

Does the number of prior caesarean sections increase PAS severity?

Yes, the risk of invasive PAS, massive haemorrhage, and the need for blood transfusions increases significantly with each additional prior caesarean section.

What is the role of placenta previa in PAS complications?

Placenta previa acts as a partial mediator. It contributes to certain risks like preterm birth and neonatal intensive care admissions but does not fully account for the total impact of prior CS on PAS.

How are neonatal outcomes affected in PAS pregnancies?

Neonatal outcomes are primarily influenced by the gestational age at the time of delivery rather than the number of previous caesarean sections the mother has had.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional relationship. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Ma Y et al. Association of caesarean section history with adverse pregnancy outcomes in placenta accreta spectrum: the mediating role of placenta previa. J Glob Health. 2026 Apr 03. doi: 10.7189/jogh.16.04045. PMID: 41926159.

Mishra P et al. Preventing the preventable: Assessing the burden of incessant caesarean deliveries in select Indian states using NFHS-5. PLoS ONE. 2025;20(4):e0320041. doi:10.1371/journal.pone.0320041.

Jauniaux E et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int J Gynaecol Obstet. 2018;140(3):265-273. doi:10.1002/ijgo.12407.