Key Predictors of Neonatal Respiratory Compromise in Placenta Accreta Spectrum: An 11-Year Retrospective Cohort Study

Background/Objectives: Placenta accreta spectrum (PAS) is associated with substantial maternal and perinatal morbidity and may lead to respiratory distress in newborns. However, limited evidence exists regarding predictors of respiratory compromise (RC) in neonates born to pregnancies complicated by PAS. Methods: This retrospective cohort study included neonates born to pregnancies complicated by PAS between 1 January 2014 and 31 December 2024. Independent predictors of RC were identified using logistic regression, and a weighted scoring model was developed. Model performance and internal validity were assessed using area under the receiver operating characteristic curve, calibration plots, and bootstrap re-sampling. Results: Among 237 neonates born to PAS-complicated pregnancies, 112 (47.3%) experienced RC. Six independent predictors were identified and assigned weighted points: maternal vaginal bleeding within 24 h before delivery (2 points); placenta type—accreta (reference), increta (1 point), and percreta (2 points); absence of antenatal corticosteroid use (1 point); gestational age—29–31 weeks (5 points) and 32–36 weeks (3 points); birth weight < 2500 g (2 points); and male sex (2 points). At a score threshold of 7, the model demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.75, sensitivity of 67.6%, and specificity of 72.9%. Conclusions: A predictive score > 7 provides fair discrimination for identifying RC in neonates born to pregnancies complicated by PAS and may assist clinicians in identifying high-risk infants who require closer monitoring and early respiratory support.