Retrospective analysis of maternal and neonatal outcomes in cases of placenta accreta spectrum: Investigating the impact of antenatal risk factors and management approaches

Objective: The aim of this study was to evaluate early diagnostic and treatment approaches for placenta accreta spectrum (PAS) and to investigate the effects of the applied treatment modalities on maternal and neonatal outcomes. Materials and Methods: This study included 210 patients diagnosed with PAS and treated at the Department of Obstetrics and Gynecology, İnönü University Faculty of Medicine, between January 1, 2014, and March 25, 2024. The clinical and demographic characteristics of the patients, surgical methods, and maternal and neonatal outcomes were retrospectively analyzed. Results: Elective surgery was performed in 66.67% of the patients, while 33.33% underwent emergency surgery. Higher rates of accreta and increta were observed in patients who underwent uterus-preserving surgery, whereas percreta was significantly more common in patients who underwent hysterectomy. Neonatal weight, as well as 1- and 5-minute APGAR scores, were significantly higher in the elective delivery group (P<0.001). Conversely, the emergency delivery group exhibited lower gestational ages, higher intraoperative blood loss, and increased neonatal complication rates. Ureteral injuries were more frequently observed in the emergency delivery group, while bladder injuries were more common in the elective delivery group (P=0.024). Pre- and postoperative hemoglobin and hematocrit levels were similar between the hysterectomy and uterus-preserving surgery groups (P=0.397 and P=0.406, respectively). No significant differences were observed between the two surgical methods in terms of intraoperative blood loss or complication rates. The anterior placental location was significantly associated with complete invasion (P<0.001). Conclusion: Deliveries performed under emergency conditions in pregnancies complicated by PAS were associated with higher risks of complications compared to planned deliveries. Based on the findings of this study, early diagnosis and meticulous delivery planning are essential for the effective management of PAS. Developing appropriate surgical strategies tailored to the type of placental invasion, alongside the adoption of individualized treatment plans, is critical for improving maternal and neonatal outcomes. Keywords: Operative Surgical Procedures, Placenta Accreta, Pregnancy Complications, Uterine Hemorrhage