ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1539998
This article is part of the Research TopicPhysiology and Pathophysiology of PlacentaView all 10 articles
Risk Factors for Emergency Cesarean Delivery in Patients with Placenta Accreta Spectrum: A Multicenter Retrospective Cohort Study
Provisionally accepted
- 1Shandong Provincial Hospital, Jinan, Shandong Province, China
- 2Qilu hospital of Shandong University dezhou hospital, Dezhou, China
- 3Qilu Hospital, Shandong University, Jinan, Shandong Province, China
- 4Jinan Maternity And Child Care Hospital, Jinan, Shandong Province, China
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Background: Pregnant women with placenta accreta spectrum (PAS), particularly those with placenta increta or placenta percreta, undergoing emergency cesarean section are at a high risk of excessive intraoperative hemorrhage and related complications. This study aimed to evaluate maternal and neonatal outcomes, and to identify risk factors associated with emergency cesarean section in women with PAS.Methods: A multicenter retrospective cohort study was conducted, including PAS patients who underwent cesarean section at three tertiary hospitals between January 2016 and January 2023. After 1:1 propensity score matching (PSM), clinical characteristics were compared between the emergency and elective cesarean section groups using Chi-square tests and nonparametric rank-sum tests. Risk factors for emergency cesarean section were identified through Cox proportional hazards regression analysis.Results: Among 299 patients included in the study, 78 were selected for analysis after PSM. In the matched cohort, patients in the emergency cesarean section group required significantly more packed red blood cell transfusions (P=0.034), had a higher rate of ascending branch ligation of the uterine artery (P <0.001), required more neonatal intensive care unit admissions (P=0.041), and delivered neonates with lower birth weight (P=0.044). Key risk factors for emergency cesarean section included a history of more than one prior cesarean section (hazard ratio [HR] 2.34, 95% confidence intervals [CI] 1.24-4.42), preoperative hemoglobin levels ≤100 g/L (HR 2.28, 95% CI 1.19-4.40), preeclampsia (HR 2.93, 95% CI 1.10-7.82), and vascular lacunae within the placenta (HR 0.40, 95% CI 0.21-0.76).Conclusions: Emergency cesarean section in PAS patients is associated with increased transfusion requirements and adverse neonatal outcomes. Close monitoring and enhanced management of patients with identified risk factors may help improve maternal and neonatal outcomes.
Keywords: Emergency cesarean, Placenta accreta spectrum, Placenta increta, placenta percreta, Propensity score matching, Perinatal outcomes, risk factor
Received: 05 Dec 2024; Accepted: 17 Aug 2025.
Copyright: © 2025 Li, Song, Li, Meng and Chu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ran Chu, Shandong Provincial Hospital, Jinan, 250021, Shandong Province, China
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