THE PURPOSE OF THE STUDY
To compare neonatal outcomes of pregnancies complicated by placenta praevia and placenta accreta depending on the gestational age to optimize the delivery time.
MATERIAL AND METHODS
A retrospective cohort study of the deliveries at 2014-2020 years with placenta praevia and clinically verified placenta accreta in the Perinatal Center of the Regional Clinical Hospital №2 in Krasnodar. Exclusion criteria: chromosomal abnormalities, congenital malformations, hemolytic disease of the fetus, multiple pregnancies, antenatal demise, incomplete data of neonatal outcome. Adjusted odds ratio (aOR) of the effect of gestational age (GA) at emergency delivery on neonatal outcomes were calculated.
RESULTS
The study included 258 patients; emergency caesarean section (eCS) — in 63 (24.4%). The frequency of eCS did not increase with increasing gestational age (<340— weeks=24; 34—350—6 weeks=16; 360—6 weeks=8; >370 weeks=15). In cases of eCS before 36 weeks of GA, there was an increase in the incidence of a low Apgar score for 5 min, asphyxia at birth, the need for oxygen support, stay in the NICU, the length of hospital stay and transfer to the second stage of nursing compared with eCS at >370 weeks (aOR=71.45; 11.55; 24.53; 24.53; 47.92; 16.64; p=0.009; 0.017; 0.024; 0.024; 0.035; 0.017 respectively). There was an additional increased risk of congenital pneumonia with eCS before 340 weeks (aOR=4.63; p=0.047). Emergency CS at 360—6 weeks compared to> 370 weeks had no additional risks apart from asphyxia and neonatal jaundice (aOR=7.14; 21.59; p=0.033; 0.035).
CONCLUSION
Prolongation of pregnancy in patients with placenta praevia and placenta accreta up to term does not increase the risk of eCS and significantly improves neonatal outcomes.