Placenta Accreta Spectrum Management and Outcomes: A Comparative Analysis of Syrian Refugees and Turkish Citizens Giving Birth in a Tertiary Hospital

Abstract

Aim: Placenta accreta spectrum disorders (PAS) are a global threat to maternal well-being. The aim of this study was to assess differences in clinical characteristics and maternal outcomes between Turkish natives and Syrian refugees giving birth with a diagnosis of PAS at a tertiary centre, and to experience the management of this condition in the unique context of Türkiye, home to one of the world's largest refugee populations. Material and Method: A retrospective study was conducted using the medical records of 228 singleton pregnancies at high risk of PAS, between January 2019 and October 2022. PAS risk assessment was initially performed by ultrasound at mid-trimester, with diagnosis confirmed histologically or clinically, indicating the presence of placental retention following attempted manual removal. The study population was divided into two groups: native and refugee. We investigated disparities in demographic and medical characteristics and primary maternal and neonatal outcomes. Results: The study found an increased prevalence of previous cesarean delivery (p=0.005), anterior placenta (p<0.000), placenta previa (p=0.047), and deeper placental invasion (increta/percreta) (p<0.000) in the native group (n=161). The native group had a significantly higher rate of estimated blood loss (2093.5±1516.4 mL vs. 714.1±731.6 mL, p<0.000) and peripartum hysterectomy (p=0.005) compared to the refugee group (n=67). The refugee group had a notably higher incidence of delayed diagnosis (p<0.000) and a shorter surgery duration (p=0.027) compared to the native group. Conclusion: The current study highlights significant differences in patient characteristics and outcomes between native and refugee pregnant women with PAS. Despite facing challenges, these women did not encounter adverse perinatal outcomes, indicating the efficacy of healthcare interventions.

Keywords

• Disparities
• placenta accreta spectrum
• Syrian refugees
• Turkish natives.

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