Objective: This study aimed to evaluate and compare neonatal outcomes in pregnancies complicated by placenta previa and placental abruption at Health Net Hospital, Peshawar, over a one-year period. Methods: A prospective observational study was conducted on 101 pregnant women diagnosed with placenta previa or placental abruption from January 2023 to January 2024. Data were collected on maternal demographics, pregnancy characteristics, delivery details, and neonatal outcomes. Statistical analysis was performed to identify differences between the two groups, with p-values <0.05 considered significant. Results: Placenta previa accounted for 50 cases, while 51 cases were due to placental abruption. ‘Neonates born to mothers with placental abruption had significantly higher NICU admission rates (68.6% vs. 60%) and neonatal mortality (19.6% vs. 8%)’. Hypoxia was significantly more common in placental abruption cases (27.5% vs. 12%, p=0.046), and NICU stay durations were longer (10.2 vs. 8.5 days, p=0.048). In contrast, cesarean delivery was significantly more frequent in placenta previa cases (96% vs. 82.4%, p=0.027). Other complications, such as respiratory distress syndrome and neonatal sepsis, were more prevalent in the placental abruption group but did not reach statistical significance. Conclusion: Neonates born to mothers with placental abruption face more severe outcomes compared to those with placenta previa, highlighting the acute nature of placental abruption and its impact on neonatal health. Early diagnosis, effective prenatal care, and timely intervention remain critical to improving neonatal outcomes in these high-risk pregnancies.