Comparison of clinical characteristics and perinatal outcomes between twin and singleton pregnancies with placenta accreta spectrum: a retrospective cohort study from a tertiary hospital in Eastern China

To investigate the different characteristics and maternal-neonatal outcomes of twin and singleton pregnancies complicated by placenta accrete spectrum (PAS). A retrospective analysis was conducted on 783 singleton and 101 twin pregnancies with PAS diagnosed during cesarean delivery at ≥ 28 weeks of gestation at Ningbo Women and Children’s Hospital from December 2018 to November 2023. Maternal demographic characteristics, obstetric features, and perioperative outcomes of the two groups were retrospectively analyzed. (1) Demographic characteristics: The two groups had similar baseline profiles in age, marital status, and occupation. Compared to singletons, women with twin PAS had a higher education level, with 64.46% holding a bachelor’s degree or higher (P < 0.05). (2) Obstetric features: The twin group had fewer gravidities, parities, uterine surgeries and intrauterine procedures, higher rates of assisted reproductive technology (ART), greater gestational weight gain, lower body mass index (BMI) and lower preoperative PAS diagnosis rates (P < 0.05). (3) Perioperative outcomes: The twin PAS group suggested higher rates of preterm delivery, invasive PAS, postpartum hemorrhage, intrauterine tamponage, blood transfusion, concordance rate in pathological diagnosis, longer postoperative antibiotic use and hospital stays, along with lower rate of placenta previa and lower birth weights in neonates (P < 0.05). No significant intergroup differences were observed in the type of cesarean section, uterine artery ligation, hysterectomy, surgeon seniority, operative time, or chorioamnionitis (P > 0.05). The primary indication for preterm delivery was PAS itself in singletons (45.8%), whereas in twins, it was most commonly spontaneous preterm labor (34.1%). Twin pregnancies with PAS present with fewer traditional risk factors than singleton, suggesting that multiple gestation may be independent risk factor for PAS. Moreover, twin PAS is associated with poorer maternal and neonatal outcomes, requiring more intensive clinical interventions and prolonged hospitalization. The lower antenatal diagnosis rate in twin pregnancies calls for heightened vigilance and improved collaboration between clinicians and radiologists to enhance screening accuracy, enabling better delivery preparation.