BackgroundTo evaluate the effect of placental location on the severity of placenta accreta spectrum (PAS).MethodsWe analyzed 390 patients with placenta previa combined with placenta accreta spectrum who underwent cesarean section between January 1, 2014 and December 30, 2020 in the electronic case database of the Second Hospital of Hebei Medical University. According to the position of the placenta, 390 placentas were divided into the posterior group (n= 89), the anterior group (n= 60) and the non-central group (n= 241).ResultsThe history of cesarean delivery rates in the anterior group (91.67%) and the non-central group (85.71%) were statistically different from the posterior group (63.74%)(P< 0.001). Univariate logistic regression results showed that employment, urban living, gestational age, complete placenta previa, fetal presentation shoulder, gravidity, cesarean section and vaginal delivery were all predictors for the severity of placenta accreta (P< 0.05). The anterior group (P= 0.001, OR = 4.13, 95%CI: 1.84–9.24) and the non-central group (P= 0.001, OR = 2.90, 95%CI: 1.55–5.45) had a higher incidence of invasive accreta placentation than the posterior group, and were independent risk factors for invasive accreta placentation.ConclusionCompared with posterior placenta, anterior and non-central placenta are independent risk factors for invasive PAS in patients with placenta previa, during which we should be more cautious in treatment.