Placenta Accreta Spectrum: Prevalence, Trend and Association with Sociodemographic/Obstetric Factors in a Tertiary Health Facility in Niger Delta, Nigeria

Background: Placenta accreta spectrum (PAS) describes the abnormal adherence of the placenta trophoblast to the myometrium and is associated with high foetal-maternal morbidity and mortality. This study was aimed at determining the prevalence and trend of placenta accreta spectrum (PAS), as well as its association with sociodemographic/obstetrics factors at the Rivers State University Teaching Hospital (RSUTH).

Methodology: An analytical cross-sectional study of all recorded cases of placenta accreta spectrum managed at RSUTH from 1st January 2016 to 31st December 2021. Descriptive and inferential statistics were derived using IBM, Statistical Product and Service Solution (SPSS) version 25.0 Armonk, NY.

Results: There were 14195 deliveries, 137 cases of placenta praevia and 39 cases of placenta accreta spectrum. The prevalence of PAS at the RSUTH was 0.27% or 2.7 /1000 deliveries or 1in 370 deliveries. The rate of PAS among cases of placenta praevia was 28.5% or 1 in 4 cases. More than half of the variants of PAS were accreta, 23 (59.0%), while 13(33.3%) and 3(7.7%) were increta and percreta, respectively. The mean (SD) age and gestational age of the participants were 32.28 (± 5.13), [95% Confidence Interval (CI): 30.63, 33.92] and 36.43(±2.01), (95%CI: 35.18, 37.07) respectively. The modal age group was 35-39 years. The median blood loss was 650mls range of 450-2000mls. The majority of the study participants were booked, 34(87.2%) and had secondary level education, 17(43.6%). History of a previous caesarean section was statistically significantly associated with PAS P<0.001, while other factors did not attain significance.

Conclusion: Placenta accreta spectrum is not uncommon among women with pregnancies complicated by placenta praevia at the RSUTH. PAS occurred more among booked multiparous women with secondary level education and with an increasing trend. History of previous caesarean section is strongly associated with PAS.