Diagnostic and Prognostic Value of Platelet Indices in Placenta Accreta Spectrum

Aim Placenta accreta spectrum (PAS) is a major obstetric emergency associated with massive hemorrhage, peripartum hysterectomy, and maternal morbidity. This study aimed to evaluate the diagnostic and prognostic value of platelet indices in PAS patients. Methods A retrospective study was conducted at Ankara Etlik City Hospital between August 2022 and August 2024. A total of 200 pregnant women were divided into three groups: PAS ( n = 63), placenta previa ( n = 67), and controls ( n = 70). Maternal demographics, delivery outcomes, neonatal parameters, and laboratory results were analyzed. Platelet indices—platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (P‐LCR)—were obtained from first trimester and preoperative blood counts. Receiver operating characteristic (ROC) analysis determined predictive cut‐off values. Multivariate logistic regression was performed to identify independent predictors of hysterectomy. Results First‐trimester MPV < 10.45 demonstrated the highest discriminatory performance for predicting peripartum hysterectomy (AUC = 0.709, sensitivity 70.9%, specificity 71.4%). Third‐trimester MPV, PDW, and P‐LCR also showed moderate predictive value. First‐trimester PDW > 12.75 predicted postpartum hemorrhage (AUC = 0.678), while PDW > 12.35 was associated with composite adverse neonatal outcomes (AUC = 0.597). In placenta previa patients, first‐trimester PCT < 0.26 predicted PAS (AUC = 0.627). In multivariate analysis, only first‐trimester MPV remained independently associated with hysterectomy (aOR 0.647, 95% CI 0.428–0.979; p = 0.040). Conclusions Platelet indices show statistically significant but moderate associations with adverse outcomes in PAS. First‐trimester MPV may serve as an early adjunctive marker in high‐risk pregnancies; however, these parameters should not replace imaging modalities and require validation in prospective multicenter studies.