Planned versus Unplanned Delivery for Placenta Accreta Spectrum

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Obstetrics

Background:

• Placenta accreta spectrum (PAS) poses significant risks during pregnancy and delivery.
• Unplanned deliveries in women with PAS may lead to increased maternal and neonatal complications compared to planned deliveries.
• Understanding the specific risks associated with unplanned PAS deliveries is crucial for improving patient outcomes.

Purpose of the Study:

• To compare severe maternal morbidity between women with PAS undergoing planned versus unplanned delivery.
• To evaluate and compare neonatal outcomes in planned versus unplanned PAS deliveries.
• To identify the need for interventions to mitigate adverse outcomes in unplanned PAS deliveries.

Main Methods:

• Retrospective cohort study of 109 women with histologically proven PAS who underwent hysterectomy.
• Comparison of severe maternal morbidity (≥4 RBC units transfused or ureter/bowel injury) and composite neonatal morbidity between planned and unplanned delivery groups.
• Analysis of demographic, clinical, and sonographic characteristics, with statistical significance set at p < 0.05.

Main Results:

• Unplanned delivery occurred in 37.6% of women with PAS.
• Women with unplanned deliveries had lower gestational age (30.3 vs. 33.8 weeks) and higher rates of severe maternal morbidity (63% vs. 36%) and ICU admission (39% vs. 17.7%).
• Neonatal morbidity did not significantly differ between planned and unplanned delivery groups.

Conclusions:

• Unplanned cesarean hysterectomy in PAS cases, occurring in approximately 40%, is associated with substantially increased maternal morbidity.
• There is a critical need for interventions to reduce the rate of adverse outcomes in women experiencing unplanned PAS deliveries.
• Some women with PAS may benefit from earlier scheduled delivery to mitigate risks.