The critical role of diagnostic accuracy in differentiating uterine dehiscence and placenta accreta spectrum to enhance neonatal outcomes in complex cesarean sections

This study aims to analyze the key factors that contribute to adverse neonatal outcomes in complex cesarean sections with a high risk of placenta accreta spectrum (PAS). A retrospective analysis was conducted on 454 records collected between January 2018 and December 2023 at a single tertiary hospital, Dr. Soetomo General Hospital, Surabaya, East Java. The PAS diagnosis was confirmed intraoperatively. Clinical outcomes, including gestational age, birth weight, birth length, Apgar score at 5 min, NICU admission, and neonatal complications, were compared between the PAS and uterine dehiscence groups. Adverse neonatal outcome is defined as Apgar score of less than 7 in 5 min. Univariate and multivariate logistic regression analyses were employed to identify factors associated with composite adverse neonatal outcomes. A total of 443 cases with high suspicion of PAS were included in the analysis, of which 383 were confirmed as PAS and the remaining as uterine scar dehiscence. Multivariable binary logistic regression revealed that preterm delivery was significantly associated with an increased risk of composite adverse neonatal outcomes (adjusted odds ratio [aOR] 5.50; 95% confidence interval [CI]: 3.46–8.53; p< 0.001). Furthermore, emergency surgery was identified as a significant risk factor (aOR 2.37; 95% CI: 1.04–4.00; p= 0.001). When comparing PAS and uterine dehiscence cases, the latter group had significantly higher gestational age at delivery (p = 0.002), better 5-minute Apgar scores (p < 0.001), greater birth weight (p < 0.001), longer birth length (p = 0.047), shorter hospital stay (p < 0.001), and a lower incidence of respiratory distress syndrome (p = 0.010). Preterm delivery and emergency delivery are primary risk factors contributing to composite adverse neonatal outcomes in pregnancies complicated by high-risk PAS. Early detection, detailed prenatal planning, and targeted clinical management are essential strategies to reduce adverse neonatal outcomes in these high-risk cases.