Prediction of placenta accreta spectrum in placenta previa surgery using systemic inflammatory markers

Authors

Ahmet Beyazıt, Kenan Serdar Dolapçıoğlu, Oya Soylu Karapınar, Bircan Kara, Hasan Cem Sevindik
https://doi.org/10.18621/eurj.1657532
Objectives: Despite advancements in medical science, existing methodologies for predicting placental invasion in patients with previa remain insufficient. Systemic inflammatory markers have emerged as potential prognostic indicators in oncology. This study aims to explore whether systemic inflammatory parameters can predict placenta accreta spectrum (PAS) in patients with previa, given the analogous mechanisms between PAS and cancer cell invasion.
Methods: This retrospective case-control study encompassed patients diagnosed with placenta previa who underwent cesarean section procedures between 2010 and 2024. The case group (PAS+) comprised patients who underwent hysterectomy, segmental resection (with histopathologically confirmed PAS), or had in situ placenta. Conversely, the control group (PAS-) included other patients. The systemic immune-inflammatory index (SII), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were calculated from the most recent preoperative complete blood count. A comparative analysis of demographic data, clinical findings, and systemic inflammatory markers was conducted between the groups.
Results: A total of 487 patients were analyzed, with 146 (30%) classified as PAS (+) and 341 (70%) as PAS (-). The PAS (+) group exhibited significantly higher values in terms of age, gravidity, parity, and the number of prior cesarean sections (P=0.004, P<0.001, P=0.018, and P<0.001; respectively). However, no significant correlation was identified between the two groups concerning systemic inflammatory markers.
Conclusions: Systemic inflammatory markers do not appear to be reliable for predicting placental invasion in previa patients.
Placenta previa, placenta accreta spectrum, systemic immune-inflammatory index, inflammatory biomarkers

1. Horng HC, Lai MJ, Chang WH, Wang PH. Placenta accreta spectrum (PAS) and peripartum hysterectomy. Taiwan J Obstet Gynecol. 2021;60(3):395-396. doi: 10.1016/j.tjog.2021.03.001.

2. Dogan O, Pulatoglu C, Yassa M. A new facilitating technique for postpartum hysterectomy at full dilatation: Cervical clamp. J Chin Med Assoc. 2018;81(4):366-369. doi: 10.1016/j.jcma.2017.05.010.

3. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017;130(4):e168-e186. doi: 10.1097/AOG.0000000000002351.

4. Crane JM, Van den Hof MC, Dodds L, Armson BA, Liston R. Maternal complications with placenta previa. Am J Perinatol. 2000;17(2):101-105. doi: 10.1055/s-2000-9269.

5. Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR; Society of Gynecologic Oncology; American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Placenta Accreta Spectrum. Am J Obstet Gynecol. 2018;219(6):B2-B16. doi: 10.1016/j.ajog.2018.09.042.

6. Soyer P, Morel O, Tsatsaris V, Bourgioti C, Barat M. Placenta Accreta Spectrum: A Continuously Evolving Challenge for Radiologists. Can Assoc Radiol J. 2021;72(4):597-598. doi: 10.1177/0846537120984124.

7. Tinari S, Buca D, Cali G, et al. Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021;57(6):903-909. doi: 10.1002/uog.22183.

8. Rekowska AK, Obuchowska K, Bartosik M, et al. Biomolecules Involved in Both Metastasis and Placenta Accreta Spectrum-Does the Common Pathophysiological Pathway Exist? Cancers (Basel). 2023;15(9):2618. doi: 10.3390/cancers15092618.

9. Feng Z, Wen H, Bi R, et al. Preoperative Neutrophil-to-Lymphocyte Ratio as a Predictive and Prognostic Factor for High-Grade Serous Ovarian Cancer. PLoS One. 2016;11(5):e0156101. doi: 10.1371/journal.pone.0156101.

10. Akın MN, Kasap BH, Yuvacı HU. Neutrophil-to-lymphocyte ratio and platelet distribution in patients with endometrial cancer. J Obstet Gynaecol Res. 2015;41(9):1499. doi: 10.1111/jog.12723.

11. Huang Y, Chen Y, Zhu Y, et al. Postoperative Systemic Immune-Inflammation Index (SII): A Superior Prognostic Factor of Endometrial Cancer. Front Surg. 2021;8:704235. doi: 10.3389/fsurg.2021.704235.

12. Han X, Liu S, Yang G, et al. Prognostic value of systemic hemato-immunological indices in uterine cervical cancer: A systemic review, meta-analysis, and meta-regression of observational studies. Gynecol Oncol. 2021;160(1):351-360. doi: 10.1016/j.ygyno.2020.10.011.

13. Dinc K, Issın G. Novel marker to predict rupture risk in tubal ectopic pregnancies: the systemic immune-inflammation index. Ginekol Pol. 2023;94(4):320-325. doi: 10.5603/GP.a2023.0010.

14. Turgut E, Yildirim M, Sakcak B, Ayhan SG, Tekin OM, Sahin D. Predicting miscarriage using systemic immune-inflammation index. J Obstet Gynaecol Res. 2022;48(3):587-592. doi: 10.1111/jog.15156.

15. Conde-Rico ET, Naves-Sánchez J, González AP, Luna-Anguiano JLF, Paque-Bautista C, Sosa-Bustamante GP. [Inflammatory indexes and their association with the severity of preeclampsia]. Rev Med Inst Mex Seguro Soc. 2023;61(Suppl 2):S178-S184. [Article in Spanish]

16. Li L, Zhang J, Gao H, Ma Y. Nestin is highly expressed in foetal spinal cord isolated from placenta previa patients and promotes inflammation by enhancing NF-κB activity. Biomarkers. 2018;23(6):597-602. doi: 10.1080/1354750X.2018.1468824.

17. Biswas R, Sawhney H, Dass R, Saran RK, Vasishta K. Histopathological study of placental bed biopsy in placenta previa. Acta Obstet Gynecol Scand. 1999 Mar;78(3):173-9.

18. Keles A, Dagdeviren G, Yucel Celik O, et al. Systemic immune-inflammation index to predict placenta accreta spectrum and its histological subtypes. J Obstet Gynaecol Res. 2022;48(7):1675-1682. doi: 10.1111/jog.15254.

19. Abide Yayla C, Ozkaya E, Tayyar A, Senol T, Senturk MB, Karateke A. Predictive value of complete blood count parameters for placental invasion anomalies. J Matern Fetal Neonatal Med. 2017;30(19):2324-2328. doi: 10.1080/14767058.2016.1247266.

20. Van Oostrom AJ, Sijmonsma TP, Rabelink TJ, Van Asbeck BS, Cabezas MC. Postprandial leukocyte increase in healthy subjects. Metabolism. 2003;52(2):199-202. doi: 10.1053/meta.2003.50037.

21. Dhabhar FS, Miller AH, Stein M, McEwen BS, Spencer RL. Diurnal and acute stress-induced changes in distribution of peripheral blood leukocyte subpopulations. Brain Behav Immun. 1994;8(1):66-79. doi: 10.1006/brbi.1994.1006.

22. Maes M, Stevens W, Scharpé S, et al. Seasonal variation in peripheral blood leukocyte subsets and in serum interleukin-6, and soluble interleukin-2 and -6 receptor concentrations in normal volunteers. Experientia. 1994;50(9):821-829. doi: 10.1007/BF01956463.

There are 22 references in total.
1.
Beyazıt A, Dolapçıoğlu KS, Soylu Karapınar O, Kara B, Sevindik HC. Prediction of placenta accreta spectrum in placenta previa surgery using systemic inflammatory markers. Eur Res J. 2025;11(6):1227-1234. doi:10.18621/eurj.1657532

Downloads

Article Information

  • Article Type Research Article
  • Submitted February 21, 2026
  • Published November 3, 2025
  • Issue Vol. 11 No. 6 (2025)
  • Section Research Article
  • File Downloads 261
  • Abstract Views 133
  • Altmetrics
  • Share
Download data is not yet available.