Abstract:

Objective To investigate the prenatal diagnosis and perinatal outcomes between anterior placenta accreta and non-anterior placenta. Methods A retrospective analysis was done for 560 pregnant women who were diagnosed with placenta accreta and delivered in the Third Affiliated Hospital of Guangzhou Medical University.According to the location of the placenta， the group was dividing into anterior placenta accreta group （319 cases） and non-anterior placenta accreta group （241 cases）. The general characteristics， maternal and infant outcomes of the two groups were analyzed. The non-anterior placenta accrete group （241 cases） then were dividing into two groups according to the time of clear diagnosis. Those who were firstly diagnosed with placenta accrete during or after the operation was the intrapartum diagnosis group （missed diagnosis） （70 cases）， and those who were diagnosed with clear placenta accreta before the delivery was prenatal diagnosis group （171 cases）. The general characteristics， maternal and infant outcomes of the two groups were also analyzed. Results There were statistically significant differences in the parity， history of cesarean section， delivery mode， degree of placenta accreta， missed diagnosis rate， neonatal birth weight， and hysterectomy rate between the non-anterior placenta accrete group and the anterior placenta accreta group. In the case of prenatal diagnosis of different degrees of placenta accreta， the prenatal diagnosis rate of placental adhesion in the non-anterior placenta accreta group was lower than that of the anterior placenta accreta group， which was statistically significant. In the non-anterior placenta accrete group， there were statistically significant differences in the age， cesarean section history， placenta previa status， mode of delivery， degree of implantation， 24-hour bleeding volume， blood transfusions， NICU transfer rate， uterine loss rate between the intrapartum diagnosis group （missed diagnosis） and the prenatal diagnosis group. Conclusions The high-risk factors of patients with non-anterior placenta accreta are different from those of patients with anterior placenta accreta. Multiple births and a history of cesarean section are high-risk factors for anterior placenta accreta patients. Non-anterior placenta accreta are more likely to be missed diagnosed， especially the placental adhesion. For pregnant women with non-anterior placenta accreta missed diagnosis， there is a high rate of adverse birth outcomes， especially in the rate of neonatal transfer to the NICU.

Key words: placenta accreta, caesarean section, postpartum hemorrhage, perinatal outcome