Comparative analysis of neonatal outcomes in placenta previa and placenta previa with placenta accreta spectrum in women with uterine scar after previous cesarean section
DOI:
https://doi.org/10.15574/HW.2025.4(179).5563Keywords:
placenta previa, placenta accreta spectrum, cesarean section, uterine scar, neonatal outcomesAbstract
The increasing rate of cesarean section (CS) has led to a higher risk of abnormal placentation. Placenta previa (PP) and its combination with placenta accreta spectrum (PP+PAS) in women with a uterine scar after previous CS are interrelated conditions that significantly affect neonatal outcomes.
Aim - to compare neonatal outcomes in PP and PP+PAS in women with a uterine scar after prior CS.
Materials and methods. A total of 205 pregnant women were examined in 2022-2025: Group I - PP without PAS (n=66), Group II - PP+PAS (n=79), and Group III - control without PP or PAS (n=60). Neonatal condition at birth, perinatal complications, rooming-in, and causes of neonatal death were analyzed. Statistical analysis was performed using Student's t-test and χ²; p<0.05.
Results. The rate of emergency CS in the PP+PAS group was 32.9%. Mean birth weight was lower in PP+PAS (2610 g) than in PP (2890 g) and controls (3310 g), with lower Apgar scores. The incidence of complications in PP vs PP+PAS was: fetal distress 27.3% vs 43.0%; asphyxia 18.2% vs 36.7%; respiratory distress syndrome 21.2% vs 40.5%; hypoxic-ischemic encephalopathy 12.1% vs 26.6%; anemia 15.2% vs 31.6%; infectious complications 10.6% vs 22.8%. Transient disorders during rooming-in (low birth weight, hypoglycemia) occurred in PP in 9.1% and 15.1%, and in PP+PAS in 15.2% and 22.8%, respectively. PP+PAS was associated with a fivefold increase in neonatal mortality and severe outcomes.
Conclusions. PP+PAS is associated with earlier delivery, a higher rate of emergency CS, poorer neonatal condition, and a fivefold increase in neonatal mortality, whereas mortality was minimal or absent in isolated PP and controls.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all participants.
The authors declare no conflict of interest.
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