Ultrasonographic Diagnosis of Placenta Accreta Spectrum (PAS) Disorder: Ideation of an Ultrasonographic Score and Correlation with Surgical and Neonatal Outcomes

Valentina Del Negro,Enrico Ciminello,Cecilia Galli,Maria Grazia Piccioni,Ludovico Muzii,Natalia Aleksa,Flaminia Vena,Martina Derme

doi:10.3390/diagnostics11010023

Valentina Del Negro, Enrico Ciminello + Show 6 more

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https://doi.org/10.3390/diagnostics11010023

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Journal: Diagnostics	Publication Date: Dec 25, 2020
Citations: 12	License type: CC BY 4.0

Affiliation: Sapienza University of Rome

Abstract

The objective of this study was to evaluate a novel ultrasonographic scoring system for the diagnosis of PAS and the prediction of maternal and neonatal outcomes. In this retrospective study, 138 patients with at least one previous caesarean section (CS) and placenta previa were included. They were divided into four groups ranging from Group 0 (Non PAS) to Group 3 (Placenta Percreta) according to the histological or surgical confirmation. Their ultrasound examinations during pregnancy were reviewed according to the nine different ultrasound signs reported by the European Working Group on Abnormally Invasive Placenta. For each parameter, 0 to 2 points were assigned. The sum of the points reflects the severity of PAS with a maximum score of 20. The scoring system revealed good performances in evaluation metrics, with an overall accuracy of 94%. In addition to this, patients’ characteristics and surgical and neonatal outcomes were analyzed with an evidence of higher incidence of complications in severe forms. Our study suggests that antenatal ultrasonographic diagnosis of PAS is feasible with sufficient level of accuracy. This will be important in identifying high-risk patients and implementing preventive strategy.

Highlights

Received: 4 November 2020Accepted: 22 December 2020Published: 25 December 2020Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.license
Formerly known as pathologically adherent placenta, defines a group of conditions characterized by abnormal adhesion and/or invasion of the placental trophoblast to the uterine myometrium
The spectrum comprehends placenta accreta, placenta increta, and placenta percreta [1]

Summary

Introduction

Formerly known as pathologically adherent placenta, defines a group of conditions characterized by abnormal adhesion and/or invasion of the placental trophoblast to the uterine myometrium. These patients, have an increased risk of severe hemorrhage frequently requiring blood transfusion. Both hysterectomy rates and maternal deaths are higher in this group of patients [4]. Can lead to multisystem organ failure, disseminated intravascular coagulation (DIC), need for intensive care unit, hysterectomy, and even death [1]. In case of an appropriate antepartum diagnosis instead, the outcomes are definitely better and the patient can be licenses/by/4.0/)

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