# Placenta Accreta Spectrum in Mauritania: Epidemiological Characteristics, Clinical Challenges, and Management Perspectives

## TL;DR

This study examines placenta accreta spectrum in Mauritania, highlighting its incidence, risk factors, and management challenges.

## Contribution

The study provides the first detailed analysis of PAS in Mauritania, emphasizing local clinical challenges and management strategies.

## Key findings

- PAS incidence was 0.15% with a mean maternal age of 35.3 years.
- Previous cesarean section, high multiparity, and advanced maternal age were main risk factors.
- Cesarean hysterectomy was the primary treatment, often requiring blood transfusion.

## Abstract

Background: Placenta accreta spectrum (PAS) represents an increasingly prevalent global health concern, associated with significant maternal morbidity and mortality. The burden is particularly critical in low-income countries. This study reports the experience of Mauritania in the management of PAS.

Methodology: A retrospective cross-sectional observational study was conducted at the Mother-Child Hospital Center of Nouakchott (CHME), the national referral center for gynecological, obstetric, and pediatric pathologies, between January 1, 2023, and December 31, 2024. All cases of PAS diagnosed and managed during this period were included.

Results: A total of 25 cases of PAS were identified among 16,658 deliveries, corresponding to an incidence of 1.50 per 1,000 births (0.15%). The mean maternal age was 35.3 years. The main risk factors observed were previous cesarean section, high multiparity, and advanced maternal age. Blood transfusion was a cornerstone of management. Most patients underwent primary radical surgical treatment with cesarean hysterectomy. Surgical complications represented the main adverse outcomes.

Conclusions: PAS is an emerging and challenging reality in Mauritania. The high prevalence of risk factors and the frequent need for transfusion emphasize the importance of establishing dedicated referral centers. Planned, multidisciplinary, and early management in specialized facilities is crucial to improving maternal and perinatal outcomes.