Novel Risk Factors for Placenta Accreta Spectrum in Women Without Prior Cesarean Section: Insights From a Case-Control Study

Placenta accreta spectrum (PAS) is a significant contributor to maternal morbidity and mortality, often complicating pregnancies due to abnormal placental attachment. While cesarean section (CS) remains the most recognized risk factor, nearly one-third of PAS cases occur in women without a history of CS. Identifying risk factors in these women is critical for improving early detection and management. This study aims to investigate maternal characteristics and risk factors associated with PAS in women without a history of CS, focusing on surgical histories and other potential predictors. A case-control study was conducted at the Maternity Teaching Hospital in Sulaimania, Kurdistan Region, Iraq. The study included 120 pregnant women diagnosed with placenta previa: 60 with PAS (cases) and 60 without PAS (controls). Women with a history of CS or uterine surgery were excluded. Data on maternal age, body mass index (BMI), parity, uterine surgical history, and other clinical factors were analyzed. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors. Significant risk factors for PAS included previous uterine myomectomy by laparotomy (OR 65.23, 95% CI: 7.85-541.72, P<0.0001), uterine septum excision (OR 9.45, 95% CI: 1.10-81.23, P=0.022), and a history of multiple endometrial biopsies (OR 3.92, 95% CI: 1.03-14.93, P=0.045). Repeated uterine curettage also emerged as a significant predictor (OR 3.78, 95% CI: 1.05-13.59, P=0.042). Conversely, traditional risk factors such as multiparity, gestational hypertension, and diabetes mellitus were not significantly associated with PAS in this cohort. Our study highlights uterine myomectomy, septum excision, repeated biopsies, and curettage as significant risk factors for PAS in women without a history of CS. These findings emphasize the importance of careful monitoring and risk assessment in such patients to improve early detection and management of PAS.