Role of Inflammatory and Coagulation Biomarkers in Distinguishing Placenta Accreta from Placenta Previa and Associated Hemorrhage

<b>Objectives:</b> This study aimed to differentiate patients with placenta accreta spectrum (PAS) from those with placenta previa (PP) and to assess the association between preoperative inflammatory and coagulation parameters and intraoperative blood loss. <b>Methods:</b> In this retrospective case-control study, 545 pregnant women were enrolled and divided into five groups: control (<i>n</i> = 251), PP (<i>n</i> = 246), PP with accreta (PPA, <i>n</i> = 18), PP with increta (PPI, <i>n</i> = 27), and PP with percreta (PPP, <i>n</i> = 33). Preoperative serum levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), delta neutrophil index (DNI), prothrombin time, fibrin degradation products (FDPs), D-dimer, and activated partial thromboplastin time (APTT) were analyzed. <b>Results:</b> The PPP group demonstrated significantly higher values of FDP, D-dimer, NLR, PLR, SII, SIRI, and DNI, and lower APTT values compared to the other groups (<i>p</i> < 0.001). For predicting PAS, SIRI and DNI showed the highest diagnostic performance, each achieving 100% sensitivity and specificity, with optimal cut-off values of 2.01 and 2.45, respectively. For predicting intraoperative blood loss ≥1000 mL, PLR and SIRI exhibited the highest diagnostic accuracy, with optimal cut-off values of 122.5 (sensitivity 76.6%; specificity 72.6%) and 2.25 (sensitivity 73.4%; specificity 74.1%), respectively. <b>Conclusions:</b> FDP, D-dimer, NLR, PLR, SII, SIRI, and DNI may serve as valuable biomarkers for differentiating PP from PAS, thereby enhancing preoperative risk assessment and guiding surgical planning to improve maternal outcomes. Additionally, PT, D-dimer, FDP, NLR, and DNI were identified as significant independent predictors of intraoperative blood loss.