Value of ultrasound scoring system for assessing risk of pernicious placenta previa with accreta spectrum disorders and poor pregnancy outcomes.

Abstract

To evaluate a system for assessing the risk of pernicious placenta previa (PPP) with placenta accreta spectrum (PAS) disorders and poor pregnancy outcomes. This prospective study focused on PPP women at ≥ 28weeks' pregnancy. Transabdominal or transvaginal ultrasonography was used to assess PAS and poor pregnancy outcomes with a system involving uteroplacental demarcation, number and size of lacunae, bladder line, and placental basal and lacunae flow. Every item was assigned 0-2 points, and the sum yielded the final score. Diagnosis of PAS was based on surgery or pathology. One or more of postpartum hemorrhage (PPH) ≥ 1000ml, hysterectomy, and organ invasion were regarded as a poor pregnancy outcome. Receiver operating characteristic (ROC) curves were generated. Fifty-one PPP women were included, with 70.6% having PAS and 75.0% of PAS women having a poor pregnancy outcome. The incidence of PAS diagnosis was 36.4% for those with a score < 5 points, with 0% having a poor outcome; 76.5% for those with a score ≥ 5 to < 8 points, with 61.5% having a poor outcome; and 100% for those with a score ≥ 8 points, with 100% having a poor pregnancy outcome. The system for predicting PPP with PAS and poor pregnancy outcomes was of high accuracy.