Neonatal Respiratory Outcomes in Placenta Previa with Histopathologically Confirmed Placenta Accreta Spectrum

Background and Objectives: Placenta accreta spectrum (PAS) complicating placenta praevia is associated with increased maternal morbidity; however, neonatal respiratory burden may be underappreciated. We compared neonatal outcomes between pregnancies complicated by placenta praevia with and without histopathologically confirmed PAS, with additional adjustment of respiratory outcomes for gestational age at delivery. Materials and Methods: We conducted a retrospective single-centre cohort study (n = 82). Based on placental histopathology, women were classified as PAS (n = 37; accreta/increta/percreta) or non-PAS (n = 45). Respiratory endpoints included respiratory resuscitation at birth, non-invasive respiratory support, and supplemental oxygen requirement with fraction of inspired oxygen (FiO₂) > 0.21 during neonatal intensive care unit (NICU) hospitalization. Logistic regression models adjusted respiratory endpoints for gestational age. Results: Data were available for 80/82 neonates. Compared with non-PAS, PAS cases had higher rates of respiratory resuscitation at birth (26/36 [72.2%] vs. 19/44 [43.2%], p = 0.013), non-invasive respiratory support (31/36 [86.1%] vs. 24/44 [54.5%], p = 0.003), and supplemental oxygen requirement (29/36 [80.6%] vs. 21/44 [47.7%], p = 0.003). After adjustment for gestational age, PAS remained associated with respiratory resuscitation (adjusted odds ratio [aOR] 3.34, 95% confidence interval [CI] 1.21-9.27; p = 0.020) and supplemental oxygen requirement (aOR 4.60, 95% CI 1.35-15.75; p = 0.015). The association with non-invasive respiratory support did not reach statistical significance (aOR 4.46, 95% CI 0.92-21.68; p = 0.064). Conclusions: Histopathologically confirmed PAS was associated with higher neonatal respiratory support requirements after adjustment for gestational age, supporting anticipatory obstetric-neonatal planning when PAS is suspected.