Maternal and neonatal outcomes in placenta accreta spectrum: Influence of antenatal diagnosis and surgical strategy.

OBJECTIVE

This study aimed to evaluate the influence of antenatal diagnosis and surgical management strategies on maternal and neonatal outcomes in placenta accreta spectrum (PAS) disorders, emphasizing risk factors, timing of delivery, and operative approaches.

MATERIALS AND

METHODS

A retrospective cohort analysis was conducted on 210 women with histopathologically confirmed PAS managed at İnönü University Faculty of Medicine between January 2014 and March 2024. Demographic data, antenatal findings, delivery type, and surgical details were compared between elective and emergency procedures, as well as between uterus-preserving surgery and peripartum hysterectomy. Uterus-preserving surgery refers to conservative techniques that aim to avoid peripartum hysterectomy while controlling hemorrhage.

RESULTS

Of the total cohort, 66.7% underwent elective surgery, whereas 33.3% required emergency intervention. Emergency deliveries occurred earlier (mean 32.1 vs. 36.0 weeks, p<0.001) and were associated with higher blood loss (799 vs. 511 mL, p<0.001), increased perinatal mortality (20% vs. 1.4%, p<0.001), and greater neonatal morbidity, mainly respiratory distress syndrome (47% vs. 14%, p<0.001). Hysterectomy was required in 45.2% of patients, primarily with placenta percreta (60% vs. 23.5%, p<0.001). Anterior placental location (89.5%) strongly correlated with complete invasion (77.7%) and bladder involvement (27.7%, p=0.038). Bladder injuries were more common in elective cases, while ureteral injuries occurred more often in emergencies (p=0.024). Preoperative hematocrit independently predicted hysterectomy risk (odds ratio: 1.092, p=0.034).

CONCLUSION

Antenatal diagnosis and well-planned elective management significantly improve maternal and neonatal outcomes in PAS. Individualized surgical planning based on invasion depth and maternal condition remains essential to reduce morbidity and mortality.