Obstetric aspects and perinatal outcomes of pregnancy management and delivery in women with placenta previa and abnormally invasive placenta: own experience

Abstract

Placenta previa (PP) and placenta accreta spectrum (PAS) are associated with a high risk of major obstetric hemorrhage, preterm delivery, and impaired early neonatal adaptation. Data on the structure of neonatal morbidity in such pregnancies remain limited in Ukrainian tertiary care centers.

Aim - to identify the spectrum of neonatal abnormalities and transient pathological conditions in infants born from pregnancies complicated by PP and/or PAS in order to optimize neonatal care.

Materials and methods. This retrospective cohort study included 115 pregnancies complicated by PP and/or PAS that ended in planned or emergency cesarean delivery in 2020-2024. Eighty-five cases of PP and 30 cases of PAS were analyzed. Clinical and anamnestic data, intraoperative characteristics, placental pathomorphology, gestational age and birth weight, rates of admission to the neonatal intensive care unit (NICU), and neonatal morbidity patterns were assessed.

Results. PP and/or PAS were associated with increased rates of preterm birth, major obstetric hemorrhage, and impaired neonatal adaptation. In the PAS group, blood loss exceeded 1000 mL in 93% of cases, and the mean operative time was longer than in the PP group. Overall, 42 (36.5%) newborns required NICU admission; the leading indications were respiratory distress syndrome, other respiratory disorders, and transient tachypnea. Among 73 infants transferred to rooming-in care 27 (36.9%) developed transient adaptation disorders. In 2023-2024, the proportion of infants born before 28 weeks of gestation increased.

Conclusions. PP and PAS define a high-risk perinatal group due to the combination of prematurity, obstetric hemorrhage, and neonatal respiratory morbidity. Cesarean delivery at 37 weeks was not associated with severe neonatal pathology but was accompanied by maladaptation disorders, which requires readiness for early respiratory support and close neonatal monitoring.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Bioethics and Deontology Committee of the institution specified in this paper. Written informed consent was obtained from all participants prior to inclusion in the study.

The authors declare no conflict of interest.