Maternal and Neonatal Outcomes After Placenta Accreta: Short-Term Complications and LongTerm Neurodevelopment

1Dr. Shazia, 2Dr. Hadiqa Khalil, 3Dr. Samia Jamil, 4Dr Syeda Khalida Naeem, 5Dr Naeema utman

1Category D hospital Munda, Dir lower, KPK
2Gyenacologist,Sarhad government hospital peshawar KPK
3Assistant Professor, Narowal Medical College,1 Narowal.
4Assistant professor gynae OBS MMC teaching hospital Kech Turbat
5Professor Dr Naeema utman HMC, Peshawar

Abstract
Placenta accreta spectrum (PAS) is a life threatening obstetric disease, which is defined by the presence of
excessive placental invasion into the myometrium resulting in excessive maternal bleeding, surgical
morbidity and neonatal morbidity. Although the risks of the maternal and neonatal short term are
wellreported, there has been limited research on long-term neurodevelopmental outcomes of surviving
neonates, especially in low- and middle-income countries (1-4).
Objective
To compare short-term maternal and neonatal outcomes after PAS and determine long-term
neurodevelopmental outcomes of surviving newborns, and investigate the effect of demographic and
clinical risk factors.
Methods
It was a mixed-methods observational study with secondary analysis of international PAS outcome data and
retrospective local hospital cohort of PAS cases confirmed (n=38). Motherly outcomes measured comprised
intraoperative blood loss, transfusion need, hysterectomy and intensive care unit (ICU) admission.
Outcomes of neonatal care consisted of gestational age, birth weight, Apgar scores, hospitalization in the
NICU, and early complications. Neurodevelopmental assessment was measured over a long period of time
using structured caregiver surveys and pediatric follow-up at 612 months. Another survey (n=15) on
clinician perception was conducted. Chi-square and correlation tests (p<0.05) were used to test statistical
associations.
Results
There were 76 percent severe cases that resulted to post partum hemorrhage, 68 percent massive transfusion,
and 71 percent cesarean hysterectomy. Fifty-five percent of mothers needed an admission to the ICU.
Premature births at neonatal level were noted in 72 percent of the births and 61 percent admitted to NICU.
At neurodevelopmental follow up, 29 percent of infants exhibited mild to moderate developmental delay,
mostly motor and speech. Delayed neurodevelopment was highly related to higher maternal blood loss and
severe prematurity (p<0.01). The clinician survey ensured high perceived burden of PAS-related neonatal
morbidity that lacked the provision of structured follow-up services.
Conclusion
PAS is linked to high short-term maternal and neonatal morbidity and a quantifiable probability of poor
neurodevelopment in the long-run. Multidisciplinary surgical planning, early referral systems and
organized neonatal follow-up programs are all required to enhance survival and long term quality of life (1,
3, 9, 11, 12).
Keywords
Placenta accreta spectrum; postpartum bleeding; cesarean hysterectomy; infant outcomes; preterm delivery;
neurodevelopmental delay; maternal morbidity; intensive care.