The most highly recognized risk factor for developing placenta accreta is:

• A. Placenta previa
• B. Advanced maternal age
• C. Multiparity with 2 or more prior cesarean sections
• D. History of placenta previa in a prior pregnancy

Answer: (A)

Placenta previa is the most recognized risk factor for placenta accreta. When the placenta implants over the lower uterine segment near the cervix, the decidual layer is thinner or less developed in that area, which makes placental villi more likely to attach abnormally to or invade the myometrium. This abnormal placentation leads to the spectrum of placenta accreta disorders.

While other factors like advanced maternal age, having multiple prior cesarean deliveries, or a history of placenta previa in a previous pregnancy can increase risk, placenta previa itself is the strongest and most consistently identified predictor. The risk is even higher if previa is accompanied by uterine scarring from prior surgeries, but previa in its own right remains the key association to recognize.