Maternal and Neonatal Health Outcomes in Placenta Accreta: Short-Term Morbidity and Long-Term Neurodevelopmental Impacts
Placenta Accreta: Short-Term Morbidity and Long-Term Neurodevelopmental Impacts
DOI:
https://doi.org/10.54393/pjhs.v6i2.2223Keywords:
Placenta Accreta, Maternal Morbidity, Neonatal Outcomes, Neurodevelopmental ImpairmentAbstract
Placenta accreta (PA) is a serious maternal complication defined by abnormal attachment of the placental trophoblastic tissue to the myometrial wall of the uterus. Objectives: To evaluate the effect of placenta accreta on maternal morbidity and neonatal health outcomes, with an emphasis on long-term neurodevelopmental effects. Methods: This retrospective study was conducted at Social Security Teaching Hospital, Lahore, from October 2022 to March 2023. A total of 231 patient data was gathered for the study, comprising 77 infants delivered after third-trimester bleeding due to placenta accreta and 154 gestational age-matched controls. The maternal outcomes assessed included rates of postpartum hemorrhage, cesarean section, and peripartum hysterectomy. Neonatal outcomes were evaluated by Apgar scores, the incidence of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), and hypoglycemia. Long-term neurodevelopmental outcomes, including cerebral palsy (CP) and minor neurodevelopmental abnormalities, were followed up at 2 years. Statistical analyses were conducted using one-way ANOVA and Chi-square test using SPSS-26. Results: Infants born to mothers with PA had lower Apgar scores at 1 minute (24.7% vs. 5.2% in controls; adjusted OR-5.67), higher rates of RDS (40.3% vs. 7.8%; adjusted OR-7.42), and severe IVH (11.7% vs. 1.9%; adjusted OR-6.30). Hypoglycemia occurred in 18.2% of the PA group compared to 3.2% in controls (adjusted OR-6.41). At 24 months, 7.8% of infants with PA had cerebral palsy (adjusted OR-13.5) and 6.5% had severe developmental delays (adjusted OR-10.4). Conclusions: It was concluded that PA is a serious risk factor for maternal and neonatal morbidity and long-term neurodevelopmental impairment.
References
Arakaza A, Zou L, Zhu J. Placenta Accreta Spectrum Diagnosis Challenges and Controversies in Current Obstetrics: A Review. International Journal of Women's Health. 2023 Dec: 635-54. doi: 10.2147/IJWH.S395271. DOI: https://doi.org/10.2147/IJWH.S395271
Baughman WC, Corteville JE, Shah RR. Placenta Accreta: Spectrum of US and MR Imaging Findings. Radiographics. 2008 Nov; 28(7): 1905-16. doi: 10.1148/rg.287085060. DOI: https://doi.org/10.1148/rg.287085060
Padilla CR, Shamshirsaz AA, Easter SR, Hess P, Smith C, El Sharawi N et al. Critical Care in Placenta Accreta Spectrum Disorders—A Call To Action. American Journal of Perinatology. 2023 Jul; 40(09): 988-95. doi: 10.1055/s-0043-1761638. DOI: https://doi.org/10.1055/s-0043-1761638
Li P, Liu X, Li X, Wei X, Liao J. Clinical Outcomes and Anesthetic Management of Pregnancies with Placenta Previa and Suspicion for Placenta Accreta Undergoing Intraoperative Abdominal Aortic Balloon Occlusion During Cesarean Section. BioMed Central Anesthesiology. 2020 Dec; 20:1-9. doi: 10.1186/s12871-020-01040-8. DOI: https://doi.org/10.1186/s12871-020-01040-8
Urfalıoglu A, Öksüz G, Bilal B, Teksen S, Calışır F, Boran ÖF et al. Retrospective Evaluation of Anesthetic Management in Cesarean Sections of Pregnant Women with Placental Anomaly. Anesthesiology Research and Practice. 2020; 2020(1): 1358258. doi: 10.1155/2020/1358258. DOI: https://doi.org/10.1155/2020/1358258
Skupski DW, Lowenwirt IP, Weinbaum FI, Brodsky D, Danek M, Eglinton GS. Improving Hospital Systems for the Care of Women with Major Obstetric Hemorrhage. Obstetrics and Gynecology. 2006 May; 107(5): 977-83. doi: 10.1097/01.AOG.0000215561.68257.c5. DOI: https://doi.org/10.1097/01.AOG.0000215561.68257.c5
Fonseca A and de Campos DA. Maternal Morbidity and Mortality Due to Placenta Accreta Spectrum Disorders. Best Practice & Research Clinical Obstetrics and Gynaecology. 2021 Apr; 72: 84-91. doi: 10.1016/j.bpobgyn.2020.07.011. DOI: https://doi.org/10.1016/j.bpobgyn.2020.07.011
Liang Y, Zhang L, Bi S, Chen J, Zeng S, Huang L et al. Risk Factors and Pregnancy Outcome in Women with a History of Cesarean Section Complicated by Placenta Accreta. Maternal-Fetal Medicine. 2022 Jul; 4(03): 179-85. doi: 10.1097/FM9.0000000000000142. DOI: https://doi.org/10.1097/FM9.0000000000000142
Del Negro V, Aleksa N, Galli C, Ciminello E, Derme M, Vena F et al. Ultra-sonographic Diagnosis of Placenta Accreta Spectrum (PAS) Disorder: Ideation of an Ultra-sonographic Score and Correlation with Surgical and Neonatal Outcomes. Diagnostics. 2020 Dec; 11(1): 23. doi: 10.3390/diagnostics11010023. DOI: https://doi.org/10.3390/diagnostics11010023
Bayo AI, Babarinsa I, Jido TA, Al Obaidly S, Shahata MA. Peripartum Hemorrhage: Recent Updates in Management. InUpdates in Intensive Care of Obstetrics and gynaecology Patients. Singapore: Springer Nature Singapore. 2024 Apr (pp. 73-105). doi: 10.1007/978-981-99-9577-6_6. DOI: https://doi.org/10.1007/978-981-99-9577-6_6
Mehrabadi A, Hutcheon JA, Liu S, Bartholomew S, Kramer MS, Liston RM et al. Maternal Health Study Group of the Canadian Perinatal Surveillance System. Contribution of Placenta Accreta to the Incidence of Postpartum Hemorrhage and Severe Postpartum Hemorrhage. Obstetrics and Gynecology. 2015 Apr; 125(4): 814-21. doi: 10.1097/AOG.0000000000000722. DOI: https://doi.org/10.1097/AOG.0000000000000722
He XJ, Dai RX, Tian CQ, Hu CL. Neurodevelopmental Outcome at 1 Year in Offspring of Women with Gestational Diabetes Mellitus. Gynecological Endocrinology. 2021 Jan; 37(1): 88-92. doi: 10.1080/09513590.2020.1754785. DOI: https://doi.org/10.1080/09513590.2020.1754785
Gauster M, Moser G, Wernitznig S, Kupper N, Huppertz B. Early Human Trophoblast Development: From Morphology to Function. Cellular and Molecular Life Sciences. 2022 Jun; 79(6): 345. doi: 10.1007/s00018-022-04377-0. DOI: https://doi.org/10.1007/s00018-022-04377-0
Han X, Guo Z, Yang X, Yang H, Ma J. Association of Placenta Previa with Severe Maternal Morbidity among Patients with Placenta Accreta Spectrum Disorder. Journal of the American Medical Association Network Open. 2022 Aug; 5(8): e2228002. doi: 10.1001/jamanetworkopen.2022.28002. DOI: https://doi.org/10.1001/jamanetworkopen.2022.28002
Matsuzaki S, Mandelbaum RS, Sangara RN, McCarthy LE, Vestal NL, Klar M et al. Trends, Characteristics, and Outcomes of Placenta Accreta Spectrum: A National Study in the United States. American Journal of Obstetrics and Gynecology. 2021 Nov; 225(5): 534-e1. doi: 10.1016/j.ajog.2021.04.233. DOI: https://doi.org/10.1016/j.ajog.2021.04.233
Gardella B, Dominoni M, Caporali C, Cesari S, Fiandrino G, Longo S et al. Placental Features of Fetal Vascular Malperfusion and Infant Neurodevelopmental Outcomes at 2 Years of Age in Severe Fetal Growth Restriction. American Journal of Obstetrics and Gynaecology. 2021 Oct; 225(4): 413-e1. doi: 10.1016/j.ajog.2021.03.037. DOI: https://doi.org/10.1016/j.ajog.2021.03.037
Allen L, Jauniaux E, Hobson S, Papillon-Smith J, Belfort MA. International Federation of Gynaecology and Obstetrics Consensus Guidelines on Placenta Accreta Spectrum Disorders: Non-conservative Surgical Management. International Journal of Gynecology and Obstetrics. 2018 Mar; 140(3): 281-90. doi: 10.1002/ijgo.12409. DOI: https://doi.org/10.1002/ijgo.12409
Aryananda RA, Duvekot JJ, Van Beekhuizen HJ, Cininta NI, Ariani G, Dachlan EG. Transabdominal and Transvaginal Ultrasound Findings Help to Guide the Clinical Management of Placenta Accreta Spectrum Cases. Acta Obstetricia Et Gynecologica Scandinavica. 2024 Jan; 103(1): 93-102. doi: 10.1111/aogs.14715. DOI: https://doi.org/10.1111/aogs.14715
Nieto-Calvache AJ, Palacios-Jaraquemada JM, Aryananda R, Basanta N, Aguilera R, Benavides JP et al. How to Perform the One-Step Conservative Surgery for Placenta Accreta Spectrum Move by Move? American Journal of Obstetrics and Gynecology Master of Financial Management. 2023 Feb; 5(2): 100802. doi: 10.1016/j.ajogmf.2022.100802. DOI: https://doi.org/10.1016/j.ajogmf.2022.100802
Awoala WB and Grace OT. Clinical Outcome of Premature Babies Admitted in The Neonatal Unit of a Tertiary Hospital in Port Harcourt. International Journal of Health Sciences and Research. 2021; 12: 60-71.
Anık A, Akcan AB, Gürel Dİ, Ergin G, Türkmen MK. Characteristics of Term Neonates Admitted to the Neonatal Intensive Care Unit: A Single-center Experience. Meandros Medical and Dental Journal. 2021 Jul; 22(3). doi: 10.4274/meandros.galenos.2021.98271. DOI: https://doi.org/10.4274/meandros.galenos.2021.98271
Varagic J, Desvigne-Nickens P, Gamble-George J, Hollier L, Maric-Bilkan C, Mitchell M et al. Maternal Morbidity And Mortality: Are We Getting to the “Heart” of the Matter? Journal of Women's Health. 2021 Feb; 30(2): 178-86. doi: 10.1089/jwh.2020.8852. DOI: https://doi.org/10.1089/jwh.2020.8852
Moeini R, Dalili H, Kavyani Z, Shariat M, Charousaei H, Akhondzadeh A et al. Maternal and Neonatal Outcomes of Abnormal Placentation: A Case-Control Study. The Journal of Maternal-Fetal and Neonatal Medicine. 2021 Oct; 34(19): 3097-103. doi: 10.1080/14767058.2019.1678128. DOI: https://doi.org/10.1080/14767058.2019.1678128
Erondu C and Dunlop A. Inter-pregnancy Care: An Opportunity to Improve Women's Health and Reduce the Risk of Maternal Morbidity and Mortality. Journal of Public Health Management and Practice. 2021 May; 27(Supplement 3): S155-8. doi: 10.1097/PHH.0000000000001319. DOI: https://doi.org/10.1097/PHH.0000000000001319
Morlando M, Schwickert A, Stefanovic V, Gziri MM, Pateisky P, Chalubinski KM et al. Maternal and Neonatal Outcomes in Planned Versus Emergency Cesarean Delivery for Placenta Accreta Spectrum: A Multinational Database Study. Acta Obstetricia Et Gynecologica Scandinavica. 2021 Mar; 100: 41-9. doi: 10.1111/aogs.14120. DOI: https://doi.org/10.1111/aogs.14120
Zhong W, Zhu F, Li S, Chen J, He F, Xin J et al. Maternal and Neonatal Outcomes After Planned or Emergency Delivery for Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis. Frontiers in Medicine. 2021 Sep; 8: 731412. doi: 10.3389/fmed.2021.731412. DOI: https://doi.org/10.3389/fmed.2021.731412
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