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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 1

Category: Clinical Obstetrics

Poster Session 1

(200) Statewide Maternal Morbidity and Mortality of Previa-Associated Placenta Accreta Spectrum With Hysterectomy in California, 2007-2020

Wednesday, February 11, 2026
10:30 AM - 12:00 PM  
Objective:
Placenta accreta spectrum (PAS) is a leading cause of obstetric hemorrhage and death from hemorrhage, yet few population-level studies have reported its morbidity and mortality burden in an era of specialized care. Counseling based on outdated data may misinform patients with suspected PAS with previa, and compound distress. We aimed to quantify maternal death and severe maternal morbidity (SMM) in cases of previa-associated PAS with hysterectomy in California.

Study Design:
We conducted a retrospective cohort study using California linked vital record and maternal discharge data for births from 2007 to 2020. PAS diagnosis was identified using validated ICD-9 methodology (Creanga et al., 2015) and ICD-10 diagnosis codes for placenta accreta, increta, or percreta. Inclusion required a diagnosis of PAS, concurrent placenta previa, and cesarean hysterectomy during birth hospitalization, excluding uterine rupture. Outcomes were death and CDC-defined SMM (excluding hysterectomy) during birth hospitalization. Modified Poisson regression modeling was used to estimate the risk of SMM and SMM indicators among PAS cases compared with all other deliveries during the same period.

Results:
Among 2,283 individuals with previa-associated PAS with hysterectomy, mortality occurred in 0.53% (n=12), 58.7% experienced SMM, and 19.7% experienced non-transfusion SMM. Key contributors to SMM were blood transfusion (54.0%), disseminated intravascular coagulation (11.3%), acute respiratory distress syndrome (7.8%), ventilation (6.8%), and shock (5.8%). Nearly all SMM risks were substantially greater in PAS compared to all other deliveries (Table 1).

Conclusion:
In this large population-based cohort of previa-associated PAS with hysterectomy, maternal death during delivery hospitalization occurred in 0.53%, lower than rates reported in older datasets, while rates of SMM and non-transfusion SMM were substantial. These findings reflect recent management paradigms, inform patient counseling, and underscore the importance of risk-appropriate regionalized care planning for patients with suspected previa-associated PAS.