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Hemorrhagic morbidity in placenta accreta spectrum with and without placenta previa



The incidence of placenta accreta spectrum (PAS; pathologic diagnosis of placenta accreta, increta or percreta) continues to rise in the USA. The purpose of this study is to compare the hemorrhagic morbidity associated with PAS with and without a placenta previa.


This was a retrospective cohort study of 105 deliveries from 1997 to 2017 with histologically confirmed PAS comparing outcomes in women with and without a coexisting placenta previa. We used the Wilcoxon rank sum test to compare continuous data and Chi-square or Fisher’s exact test for categorical data. We also performed log-binomial regression to calculate risk ratios adjusted for depth of invasion (aRR) and 95% confidence intervals (CI).


We identified 105 pregnancies with PAS. Antenatal diagnosis of PAS was higher in women with coexisting placenta previa (72.3%) than those without (6.9%, p < 0.001). Women with coexisting placenta previa had greater median estimated blood loss and more units of packed red blood cells transfused (both p ≤ 0.03). Women with placenta previa were more likely to undergo a hysterectomy (RR 2.7; 95% CI 1.8–3.8) and be admitted to the intensive care unit (aRR 3.3; 95% CI 1.1–9.6).


Among women with PAS, those with a coexisting placenta previa experienced greater hemorrhagic morbidity compared to those without. In addition, PAS without placenta previa typically was not diagnosed prior to delivery. This study further supports the recommendation for multi-disciplinary planning and assurance of resources for pregnancies complicated by PAS. In addition, our results highlight the need for mobilization of resources for those pregnancies where PAS is not diagnosed until delivery.

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This work was conducted with support from Harvard Catalyst|The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.


The work was conducted with support from the Charles Koch Foundation.

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Authors and Affiliations



BMM: data curation, methodology support, and writing of the manuscript. RW: data curation and critical editting of the manuscript. AMR: data curation, methodology support and critical editing of the manuscript. AMM: data analysis, methodology support, project administration and critical editing of the manuscript. MRH: study conception, analysis support, project supervision and critical editing of the manuscript. JLH: data curation, methodology support and critical editing of the manuscript. MHS: data curation and critical editing of the manuscript. SAS: study conception, funding aquisition, methodology, project supervision and criticial editing of the manuscript.

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Correspondence to Scott A. Shainker.

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Mulla, B.M., Weatherford, R., Redhunt, A.M. et al. Hemorrhagic morbidity in placenta accreta spectrum with and without placenta previa. Arch Gynecol Obstet 300, 1601–1606 (2019).

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  • Placenta accreta spectrum
  • Placenta previa
  • Obstetrics hemorrhage
  • Maternal morbidity