Planned versus Emergency Management of Placenta Accreta Spectrum and Its Association with Maternal and Neonatal Outcomes: A Retrospective Cohort Study

Abstract

Objective: To compare maternal and neonatal outcomes between planned and emergency management of placenta accreta spectrum (PAS) in a tertiary care hospital.

Methodology: This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Combined Military Hospital Kharian Cantt from January 2024 to December 2025. Data were retrospectively extracted from hospital medical records, including patient charts, operative and anaesthetic records, blood bank records, ICU records, and neonatal charts. In total 94 patients with confirmed PAS were included and divided equally into planned management (n=47) and emergency management (n=47) groups. Maternal intraoperative, postoperative, and neonatal outcomes were compared using chi-square test and independent t-test. Multivariate logistic regression was conducted to identify predictors of adverse maternal outcomes.

Results: Emergency management was associated with significantly higher estimated blood loss (3120 ± 980 mL vs 1850 ± 640 mL; p=0.001), massive transfusion (51.1% vs 17.0%; p=0.001), cesarean hysterectomy (70.2% vs 40.4%; p=0.004), and ICU admission (66.0% vs 25.5%; p=0.001) compared with planned management. Disseminated intravascular coagulation (31.9% vs 6.4%; p=0.002), ventilator requirement (38.3% vs 8.5%; p=0.001), and sepsis (21.3% vs 4.3%; p=0.014) were also significantly more frequent in emergency cases. Neonatal outcomes were worse in the emergency group, including higher NICU admission (61.7% vs 23.4%; p=0.001), RDS (44.7% vs 14.9%; p=0.002), and neonatal mortality (12.8% vs 2.1%; p=0.049). Emergency management independently predicted adverse maternal outcomes (AOR=4.82, 95% CI: 2.01–11.54; p=0.001).

Conclusion: Planned multidisciplinary management of PAS was associated with lower maternal and neonatal outcomes compared with emergency management. Early antenatal diagnosis and timely referral to specialized tertiary care centers may substantially reduce fetomaternal morbidity and mortality associated with PAS.

Keywords: Cesarean Section; Infant, Newborn; Intensive Care Units; Maternal Health; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy Complications.