Poor postpartum hemorrhage morbidity and menstrual recovery in placenta accreta spectrum patients with placenta previa

Introduction: Placenta accreta spectrum is a complex and dangerous disease during pregnancy. We assessed the risk factors for postpartum hemorrhage and menstrual recovery in palcenta accreta spectrum patients with placenta previa. Methods: Patients were enrolled between January 2010 and January 2020. Logistic regression analysis was performed to assess the risk factors. The area under the receiver operating characteristic curve of sensitivity and specificity was used to predict the risk of menstrual recovery and postpartum hemorrhage. Results: Overall, 248 patients with placenta accreta spectrum were enrolled. Multiple logistic regression analysis showed that placental grading after delivery (p<0.001), placenta previa with implantation (p<0.001), postpartum D-dimer level (p=0.004), and albumin level (p=0.037) were independent risk factors for postpartum hemorrhage. Placental grading after delivery (p<0.001), blood transfusion (p=0.010), placenta previa with implantation (p=0.002), postpartum hemorrhage (p=0.013), and diastolic pressure (p=0.035) were independent risk factors for menstrual recovery after one year. The area under the receiver operating characteristic curve of placenta previa with implantation plus postpartum hemorrhage for predicting menstrual recovery after 1 year was 0.783 (95% confidence interval [CI]: 0.719-0.847, p<0.001), and that of placenta previa with implantation plus D-dimer was 0.717 (95% CI: 0.653-0.780, p<0.001) for predicting postpartum hemorrhage. Discussion: Postpartum hemorrhage morbidity and menstrual recovery are poor in placenta accreta spectrum patients with placenta previa.