Key result
Placenta accreta spectrum linked to ~138% greater odds of composite adverse neonatal outcomes versus controls.
Why the study?
Placenta accreta spectrum is associated with severe maternal morbidities, but neonatal outcomes compared with unaffected pregnancies needed description.
Does placenta accreta spectrum increase the risk of adverse neonatal outcomes in women undergoing cesarean delivery?
Cohort (n=1,647)
No
Does placenta accreta spectrum increase the risk of adverse neonatal outcomes in women undergoing cesarean delivery?
Odds Ratio: 2.38 (95% CI 1.4–4.05)
Absolute Event Rate: 33.6% vs 18.7%
p-value: p=0.001
Pregnancies complicated by placenta accreta spectrum are associated with a significantly higher risk of adverse neonatal outcomes, including lower Apgar scores and increased NICU admissions.
Neonates after PAS cesarean delivery face elevated adverse outcome risk; leaves open whether PAS independently drives this beyond matched gestational age and prior cesareans.
PURPOSE: Pregnancies complicated by placenta accreta spectrum (PAS) are associated with severe maternal morbidities. The aim of this study is to describe the neonatal outcomes in pregnancies complicated with PAS compared with pregnancies not complicated by PAS. METHODS: A retrospective cohort study conducted at a single tertiary center between 03/2011 and 01/2022, comparing women with PAS who underwent cesarean delivery (CD) to a matched control group of women without PAS who underwent CD. We evaluated the following adverse neonatal outcomes: umbilical artery pH < 7.0, umbilical artery base excess ≤ - 12, APGAR score < 7 at 5 min, neonatal intensive care unit (NICU) admission, mechanical ventilation, hypoxic ischemic encephalopathy, seizures and neonatal death. We also evaluated a composite adverse neonatal outcome, defined as the occurrence of at least one of the adverse neonatal outcomes described above. Multivariable regression analysis was used to determine which adverse neonatal outcome were independently associated with the presence of PAS. RESULTS: 265 women with PAS were included in the study group and were matched to 1382 controls. In the PAS group compared with controls, the rate of composite adverse neonatal outcomes was significantly higher (33.6% vs. 18.7%, respectively, p < 0.001). In a multivariable logistic regression analysis, Apgar score < 7 at 5 min, NICU admission and composite adverse neonatal outcome were independently associated with PAS. CONCLUSION: Neonates in PAS pregnancies had higher rates of adverse outcomes. Apgar score < 7 at 5 min, NICU admission and composite adverse neonatal outcome were independently associated with PAS.
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Toussia‐Cohen et al. (2024) conducted a cohort in Placenta accreta spectrum (PAS) (n=1,647). Placenta accreta spectrum vs. Pregnancies not complicated by placenta accreta spectrum was evaluated on Composite adverse neonatal outcome (umbilical artery pH < 7.0, umbilical artery base excess ≤ − 12, APGAR score < 7 at 5 min, NICU admission, mechanical ventilation, hypoxic ischemic encephalopathy, seizures, or neonatal death) (aOR 2.38, 95% CI 1.40-4.05, p=0.001). Pregnancies complicated by placenta accreta spectrum were independently associated with a significantly higher rate of composite adverse neonatal outcomes compared to matched controls (33.6% vs 18.7%, aOR 2.38).
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