Plasenta akreta spektrumunu öngörmeye yönelik bir skorlama sistemi: prospektif bir çalışma

Abstract

Purpose: The aim of this study was to assess the utility of a scoring system using selected ultrasonographic features to predict placenta accreta spectrum (PAS) and its severity in suspicion of PAS.
 Materials and Methods: This prospective study was conducted with a total of 27 pregnant women with placenta previa totalis with suspicion of PAS between 24 and 37 weeks gestation between July 2019 and January 2020. PAS score was calculated with the following parameters: loss of clear zone, number, size, and regularity of placental lacunae, turbulent flow in lacunae, uterovesical or subplacental hypervascularity, bridging vessels, and the number of previous cesarean section. Patients were divided into groups due to PAS scores and the severity of PAS. Receiver operating characteristics curves were performed to assess the performance of the PAS scoring system.
 Results: In a total of 27 patients, 7 (25.9%) patients did not have PAS, 5 (18.5%) patients had accreta, 7 (25.9%) patients had increta, and 8 patients (29.6) had percreta. In groups with PAS scores higher than 8, 86% of patients had placenta percreta. PAS score was 2.8±1.4 in the no PAS group, 3.6±1.9 in the accreta group, 5.1±2.4 in the increta group, 9.8±1.6 in the percreta group and statistically higher in the percreta group. The optimal cut-off values of the PAS score to predict abnormal placental invasion was 4.5 (60% sensitivity, 86% specificity), 7.5 for differentiation percreta from increta (87.5% sensitivity, 75% specificity)
 Conclusion: A PAS scoring system that combines several ultrasound and clinical characteristics may greatly improve prenatal risk assessment and prediction of PAS.