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Risk factors and clinical outcomes for placenta accreta spectrum with or without placenta previa



To clarify risk factors and clinical outcomes for placenta accreta spectrum (PAS) stratified by placenta previa.


We conducted registry-based multicenter cross-sectional study including 472,301 singleton deliveries between 2013 and 2015. PAS was considered as a primary outcome, as well as maternal age, parity, history of cesarean section, history of miscarriage, and assisted reproductive technology (ART) were considered as potential exposures. A multivariable Poisson regression analysis was conducted to assess the risk for PAS, stratified by placenta previa. In addition, the risk for subsequent blood transfusion and hysterectomy by each exposure using multivariable Poisson regression analysis was conducted.


There were 426 and 1827 cases of PAS with and without placenta previa. Among cases with placenta previa, the number of previous cesarean sections was the most powerful predictor for PAS [adjusted risk ratio (aRR) for one previous cesarean section 5.34, 95% confidence interval (CI) 3.70–7.71; aRR for two or more previous cesarean section 16.5, 95% CI 11.5–23.6]. Among cases without placenta previa, previous cesarean section was not a significant predictor, whereas the strongest predictor was conception through ART (aRR 5.05, 95% CI 4.50–5.66). Although the risks of PAS for blood transfusion and hysterectomy were higher among cases with placenta previa, those without placenta previa also demonstrated non-negligible risks.


The current study demonstrated that history of cesarean section was the strongest risk factor for PAS among women with placenta previa. Among those without placenta previa, ART was an important predictor, but not cesarean section.

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Fig. 1

Availability of data and materials

The data that support the findings of this study are available from the Japan Society of Obstetrics and Gynecology but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the Japan Society of Obstetrics and Gynecology.

Code availability

STATA custom code cannot be shared publicly, but it is available on request from Kohei Ogawa (


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We thank the Japan Society of Obstetrics and Gynecology Perinatal Committee as well as all participating hospitals for the provision of the data used. In addition, we would like to thank the medical editor from the Division of Education for Clinical Research at the National Center for Child Health and Development for editing this manuscript.


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Authors and Affiliations



KO initiated the concept, designed the study, analyzed the data, and wrote the initial manuscript. SJ, NM, and SH gave critical comments on the study design, analysis, and interpretation, as well as revised the draft.

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Correspondence to Kohei Ogawa.

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All authors declare that they have no conflicts of interest associated with the publication of this research.

Ethical approval

The registry of the Japan Society of Obstetrics and Gynecology Perinatal Database was conducted in accordance with the guidelines of the Declaration of Helsinki and other nationally valid regulations. All participating hospitals posted that they were participating in this database and that all data would be included in the research unless noted by the physician as otherwise. The JSOG website posted a summary of all analytical studies, and each hospital notified the patients to contact their hospital if they did not want to be included. The protocol for this study was approved by the Institutional Review Board at the National Center for Child Health and Development on April 18, 2017 (No. 1448).

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Ogawa, K., Jwa, S.C., Morisaki, N. et al. Risk factors and clinical outcomes for placenta accreta spectrum with or without placenta previa. Arch Gynecol Obstet 305, 607–615 (2022).

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  • Assisted reproductive technology
  • History of cesarean section
  • Placenta accreta spectrum
  • Placenta previa