Effect of emergency/planned caesarean section on perinatal outcomes of pregnant women with placenta accreta spectrum and their neonates: a retrospective study cohort

Duan Duan^1,2Dongmei Tang¹Shimao Zhang¹Jinzhu Fu¹Linbo Cheng¹Mi Su¹Wenyi Lin¹Sumei Wei¹Wen Xiong^1,2*

• ¹Chengdu Women and Children’s Central Hospital, Chengdu, Sichuan Province, China
• ²School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China

Background: Placenta accreta spectrum (PAS) is an obstetric conditions.Our study analyzed the outcomes of PAS parturients and their newborns undergoing emergency caesarean sections compared to planned caesarean sections.In this research, we conducted a thorough retrospective analysis of 345 cases of placenta accreta at a single medical center. The cases were systematically categorized into two groups based on the type of surgical procedure: emergency caesarean sections and planned caesarean sections. A univariate analysis was performed to compare the outcomes associated with each approach. Furthermore, logistic regression analysis was used to identify independent risk factors related to emergency surgeries. To further enhance our understanding, multiple linear regression analysis was employed to determine the key factors influencing intraoperative bleeding. The selection of covariates for the regression analyses was carefully guided by previously reported influencing factors, as well as the significant differences highlighted in the univariate analysis.Missing data were addressed using multiple imputation based on chained equations to reduce potential bias and preserve analytical integrity.The study enrolled all PAS women between August 2019 to February 2022 .Ethical approval for this study was obtained from the Ethics Committee of Chengdu Women's and Children's Center Hospital (Ethics DOI: 201830). All participants provided written informed consent.Results:For mothers, the amount of bleeding and allogeneic blood transfusion in the emergency group was higher than that of the planned group. Regarding the newborns, the birth weight, length, and gestational age of newborns in the emergency group were lower than those in the planned group. The analysis found that the operation mode (B = 158.174, P =0.043, 95% CI 4.99~311.358) and the duration of operation (min) (B = 13.348, P < 0.001, 95% CI 11.878~14.817) significantly affected the amount of intraoperative bleeding.The perinatal outcome and perinatal infants in the emergency group were worse than those in the planned group, including lower neonatal birth weight, shorter body length, smaller gestational age at birth, and higher incidence of severe neonatal asphyxia. Emergency caesarean section may increase the amount of bleeding during caesarean section in PAS patients. A multidisciplinary team (MDT) managing such patients can achieve favorable outcomes.