Study Reveals Risks of Emergency Cesarean Deliveries in PAS

Placenta previa is a condition that poses significant risks to pregnant women, especially those with placenta accreta spectrum (PAS), including placenta increta or placenta percreta. These women are at high risk of complications during emergency cesarean deliveries, leading to excessive intraoperative hemorrhage and related issues. To address this, a multicenter retrospective cohort study was conducted to evaluate maternal and neonatal outcomes and identify risk factors associated with emergency cesarean deliveries in PAS patients.

Over recent years, the incidence of PAS has been on the rise, largely due to increasing rates of cesarean deliveries. PAS presents a severe obstetric complication where the placenta fails to detach from the uterus after delivery, potentially leading to life-threatening conditions like disseminated intravascular coagulation, ICU admission, and even maternal death. Optimal management of PAS necessitates specialized care in centers equipped with multidisciplinary teams and immediate access to necessary resources.

Despite clinical guidelines recommending planned deliveries for PAS patients, there is no consensus on the optimal timing due to varying patient conditions. A previous study indicated that a significant percentage of severe PAS cases with placenta previa required emergency cesarean deliveries, resulting in increased blood loss, maternal morbidity, and adverse neonatal outcomes. Emergency cesarean deliveries lack the preoperative preparation time needed for assessing maternal and fetal conditions, organizing blood transfusion protocols, and implementing preventive measures to control hemorrhage.

Early and accurate risk assessment is crucial to identify PAS patients at high risk of needing emergency cesarean deliveries. This is particularly relevant in cases of placenta previa complicated by suspected placenta increta or percreta, where the likelihood of emergency interventions and adverse outcomes is elevated. The study aimed to compare perinatal outcomes between emergency and planned cesarean deliveries in PAS patients using propensity score matching and identify key risk factors associated with emergency interventions.

The findings revealed that emergency cesarean deliveries in PAS patients were linked to higher transfusion requirements, more neonatal intensive care unit admissions, lower birth weights, and the need for additional interventions. Risk factors for emergency cesarean deliveries included a history of multiple prior cesarean sections, low preoperative hemoglobin levels, preeclampsia, and the presence of vascular lacunae within the placenta.

In conclusion, early diagnosis and risk stratification are essential for improving outcomes in PAS patients with placenta previa. Enhanced prenatal surveillance, especially for high-risk patients identified via imaging, can lead to better outcomes. Planning deliveries at specialized centers with experienced teams can reduce the need for emergency interventions and enhance maternal and neonatal outcomes.