Risk Factors For Placenta Accreta Research Articles

Early diagnosis of placenta accreta in case of mid trimester postabortal haemorrhage with previous 3 cesarean sections

: To know the risk and management of postabortal haemorrhage in patients with previous caesarean delivery to prevent maternal mortality. : Placenta accreta is an emergency life threatening obstetric situation may also complicate first trimester and midtrimester abortion and encountered as profuse vaginal bleeding and difficulty in placenta removal at delivery. The incidence of placenta accreta increased from 1 in 30,000 pregnancies in 1960 to 1 in 533 pregnancies in 2000. Placenta accreta developed in 55 of 590 women with placenta previa and 7 of 156080 without placenta previa. Increased incidence of caesarean increases the incidence of placenta accreta. Multiple caesarean deliveries are largest risk factor for placenta accreta. On the basis of a high risk factor, suspected case of placenta accreta spectrum, must be diagnose and be in charge of a multidisciplinary team with better maternal and fetal outcome. A 36 years old patient, P3L3A1 had prior 3 LSCS with retained placenta with profuse bleeding per vaginum with history of expulsion of fetus (18 week) on the way to hospital, presented to labor room. Patient was unbooked and uninvestigated. Initial resuscitation done along with oxytocic given but no sign of placental separation was there and bleeding was continued. On the basis of torrential bleeding and history of previous three caesarean deliveries, patient is immediately shifted to the operation theatre for exploratory laparotomy in view or provisional diagnosis of a morbidly adherent placenta with torrential haemorrhage. On laparotomy, the anterior surface of lower uterine segment of uterus accompanied by numbers of engorged blood vessels. Bladder was spared. Decision of exploratory laparotomy taken into consideration of morbidly adherent placenta, and procedure was ended with Subtotal hysterectomy, haemostasis achieved. 2 units PCV transfused intraoperatively and patient was shifted to intensive care unit for observation postoperatively. Her postoperative duration was uneventful; she got discharged on postoperative day6 under satisfactory condition. The specimen was sent for histopathological examination. Vigilant monitoring and timely intervention in obstetric emergencies can avoid maternal mortality. We wish to highlight the vigilant monitoring and timely decision, active collaboration by multidisciplinary team improve outcomes in patient of postabortal haemorrhage in midtrimester with previous caesarean delivery with placenta accreta spectrum.

Placenta Accreta Spectrum: A Current Literature Review

Objective: This literature review was designed to highlight the most up-to-date and evidence-based interventions, whenever available, regarding diagnostic imaging modalities and management strategies for patients, with the placenta accreta spectrum. Materials and Methods: A comprehensive review of the literature was conducted using database searches in Science Direct, Google Scholar, and PubMed to locate the most up-to-date information, related to this topic. Results: The placenta accreta spectrum has an unclear etiology, with cesarean delivery and placenta previa being the most implicated factors. Conclusion: There is a growing global consensus that the two main risk factors for placenta accreta are placenta previa and prior cesarean delivery. Up-to-date, grayscale sonography combined with Doppler interrogation is thought to be the best first-line assistance, for the identification of abnormal placental invasion. Cesarean hysterectomy, with placenta left in situ, is the classical surgical treatment.

Analisis Kejadian Plasenta Akreta di RSUP H. Adam Malik Medan Tahun 2016-2019

Placenta accreta is considered a life-threatening condition and is a cause of maternal death. Placenta accreta causes 7% -10% of cases of maternal mortality worldwide. Previous Sectio Ceasarea (SC) and uterine surgery are the most common risk factors for placenta accreta. Placenta accreta occurs when villous placenta invades directly into the myometrium. The incidence of placenta accreta increases with increasing incidence of SC. this wa is descriptive with a retrospective study. From 2016 – July 2019 there were 59 cases of placenta accrete with an increase in the number each year. Risk factor for the history of sectio ceasarea (94,8%). Sectio ceasarea + hysterectomy is a procedure of placenta accreta. There were no maternal mortality from 2016 – 2019 up to July. The annual incidence of placenta accreta increases each years mean risk factors dominant placenta accreta is history sectio ceasarea.

Placenta accreta index as a predictor of placental invasion in cases of placenta previa

ObjectiveThis study aims to evaluate the role of the placenta accreta index in predicting placental invasion in patients with placenta previa.Patients and methodsThis study was carried on 60 pregnant women with placenta previa (after 30 weeks gestation). They were recruited from the Obstetrics and Gynecology clinic of Menoufia University hospitals and Shebin El Kom Teaching Hospital in the period from January 2019 to December 2020.ResultsPreterm labor was found in 15 (78.95%) patients in the accreta group and six (14.36%) patients in the nonaccreta group (P = 0.000). Hysterectomy was performed in 14 (73.68%) patients in the accreta group and four (9.76%) patients in the nonaccreta group (P = 0.000). Urological complications occurred in five (26.32%) patients in the accreta group and one (2.44%) patient in the nonaccreta group (P = 0.004). Blood transfusion was needed in 16 (84.21%) patients in the accreta group and seven (17.07%) patients in the nonaccreta group (P = 0.000). ICU transfer was needed in 10 (52.63%) patients in the accreta group and two (4.88%) patients in the nonaccreta group (P = 0.000).ConclusionsBoth grayscale and color Doppler ultrasound were very important in the prenatal diagnosis of placenta accreta to reduce maternal and perinatal mortality and morbidity, but color Doppler had higher sensitivity and specificity. Placenta accreta index score 4 can be used as a predictive cutoff value for prediction of placental invasion in patients with placenta previa. Placenta previa in current pregnancy, previous uterine scar, increased maternal age, number of dilation and curettage and number of pregnancies and labors, and the presence of previous history of placenta previa are all risk factors for placenta accreta, and placenta accreta is associated with increased postoperative morbidity. It is associated with increased blood loss, risk of blood transfusion, ICU admissions, wound sepsis, urological complications, and poor neonatal outcome.

Evaluation of the diagnosis and treatment of cesarean scar pregnancy induced in the second trimester: a national multicenter retrospective study

Objective: To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester. Methods: A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared. Results: Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta (P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95%CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness (OR=0.033, 95%CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions: (1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Analysis of risk factors for obstetric outcomes after hysteroscopic adhesiolysis for Asherman syndrome: A retrospective cohort study.

To investigate the factors influencing placenta accreta in pregnant women who previously underwent hysteroscopic adhesiolysis (HA). This retrospective study enrolled 265 women with intrauterine adhesions (IUAs) at the Sir Run Run Shaw Hospital from January 2014 to December 2018. We followed up their pregnancy outcomes and maternal complications. The menstrual pattern and gestational history before operation were significantly different between the live birth and pregnancy loss groups. The age, extent of cavity involved, type of adhesions, times of adhesiolysis performed, and time interval from surgery to pregnancy were not significantly different between these two groups. In the third trimester, 48 of 140 patients had 53 perinatal complications, including placenta accreta (27), gestational diabetes mellitus (10), pregnancy-induced hypertension (6), postpartum hemorrhage (4), intrahepatic cholestasis of pregnancy (2), placenta previa (1), oligohydramnios (1), and intrauterine growth restriction (1). Logistic regression analysis showed that extent of cavity involved and times of adhesiolysis performed were associated with placenta accreta. The extent of cavity involved and times of adhesive separation surgeries were risk factors for placenta accreta in patients. The menstrual model and gestational history may provide the main predictive factors for pregnancy loss.

The Role of MRI in the Assessment of Placenta Previa and Abnormal Placental Invasion

Abstract Background: Placenta accreta is a serious condition that may threaten life with increasing incidence in the past years. Placenta accreta denotes abnormal placentation including placenta accrete (direct myometrial placental abnormal attach-ment), placenta increta (myometrial placental invasion) and placenta percreta (complete placental invasion within the uterine walls with or without extra-uterine extension). Lower anterior uterine segment is the commonest site for placenta accreta. Multiple cesarean section with presence of placenta previa are considered the commonest risk factors for placenta accreta. The percent of developing placenta accreta is 24% in females having placenta previa and previous one cesarean section and rises with increased number of previous to cesarean sections. Aim of Study: This study was done aiming at the clarifi-cation of the role of MRI in the assessment of the uterine walls' invasion by the placenta in cases with placenta previa. Patients and Methods: Prospective study of 50 pregnant women with age range between 35 and 45 years old. They were all referred form the Gynecology and Obstetric Depart-ment with clinical and ultra-sonographic criteria of placenta previa with suspected abnormal placental invasion. The clinical and sonographic data were assessed followed by MRI study of the abdomen and pelvis for placental assessment. Results: This study diagnosed placenta previa accompanied by accreta in 18/50 cases & placenta previa with no abnormal placental uterine walls' invasion in 32/50 cases. After corre-lation with surgical and histo-pathological reports, 100% of the cases showed true positive results regarding the MRI detection of placenta accreta as well as true negative results occurred in 81% of cases and false negative in 19% of cases. Conclusion: MRI study offers a superior choice for as-sessment of placenta previa and detection of placental invasion of the uterine walls (accreta type).

A systematic review and meta-analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta.

The incidence of placenta accreta has increased in recent years and it has been suggested that the rising trend in cesarean delivery and other uterine surgery is the underlying cause. To explore the magnitude of the effect of performing single and repeat cesarean deliveries or other uterine surgery on the incidence of placenta accreta. Relevant databases were searched for papers published before August 1, 2018, using terms including "accreta" and "cesarean." Cohort studies assessing the risk of placenta accreta according to women's history of uterine surgery. Meta-analyses were performed to assess the risks associated between uterine surgery and placenta accreta, hysterectomy, and uterine rupture. The I2 statistic was used to examine between-study heterogeneity. The risk of placenta accreta in a second pregnancy increased for women who had undergone a cesarean in their first pregnancy compared with vaginal delivery (OR 3.02; 95% CI, 1.50-6.08). Absolute risk of placenta accreta increased with the number of previous cesareans. The risk of uterine rupture and hysterectomy was also associated with the number of cesareans. Risk of placenta accreta, hysterectomy, and uterine rupture increases with the number of previous cesarean deliveries. CRD42016050646.

Combining Clinical Characteristics and Specific Magnetic Resonance Imaging Features to Predict Placenta Accreta.

ObjectiveThe aim of this study was to explore the independent clinical and magnetic resonance imaging (MRI) performance risk factors for predicting placenta accreta.MethodsFrom January 2012 to December 2015, we retrospectively reviewed the clinical characteristics and MRI features of 97 patients. Of these, 42 were confirmed to be placenta accreta by pathological results or cesarean delivery findings. We tried to identify the independent risk factors by multivariate logistic regression model for significant differences in variables determined by univariate analysis.ResultsThe multivariate logistic regression model indicated that 2 or more instances of previous cesarean deliveries and/or abortions, placenta previa, and placenta-myometrial interface interruption were independent risk factors for placenta accreta. The odd ratios were 3.79 for patients who had 2 or more instances of previous cesarean deliveries and/or abortions, 0.04 for marginal/partial placenta previa, 0.024 for complete placenta previa, and 6.56 for placenta-myometrial interface interruption. The values of accuracy and positive prediction by combination of a single clinical risk factor and placenta-myometrial interface interruption and of positive prediction by a combination of all 3 risk factors for predicting placenta accreta were raised to 83.5%, 75%, and 92.9%, respectively. We obtained 3 different risk groups by different combinations of all 3 risk factors.ConclusionsThe study suggested that 2 or more instances of previous cesarean deliveries and/or abortion, placenta previa, and placenta-myometrial interface interruption were independent risk factors for placenta accreta. A combination of a single clinical risk factor and an MRI risk factor can improve the diagnosis of placenta accreta, and a combination of all 3 risk factors could help recognize patients with placenta accreta.

Uterine septum as a risk factor for placenta accreta in primigravid woman

Uterine septum as a risk factor for placenta accreta in primigravid woman

Clinical and Ultrasound Predictors of Placenta Accreta in Pregnant Women with Antepartum Diagnosis of Placenta Previa: A Multicenter Study

Background/Aims: Abnormally invasive placenta (AIP) includes placenta accreta, increta, and percreta and represents major complications of pregnancy. This study was designed to assess the role of ultrasonography in the identification of AIP among pregnant women with antepartum diagnosis of placenta previa. Methods: A cross-sectional study was performed between May 2015 and April 2016 in 11 centers, including 242 women with antepartum diagnosis of placenta previa. Results: Ninety-eight out of 242 (40.49%) women had a histological diagnosis of placenta accreta. A higher number of caesarean deliveries (p = 0.001) and curettages (p = 0.027) and older age of the woman at the delivery (p = 0.031) were identified as risk factors for placenta accreta. The presence of irregularly shaped placental lacunae (vascular spaces) within the placenta (p = 0.008), protrusion of the placenta into the bladder (p < 0.0001), and turbulent blood flow through the lacunae on Doppler ultrasonography (p = 0.008) were predictors of placenta accreta. Conclusions: Women with a prior delivery by caesarean section have a high incidence of placenta accreta among women with antepartum diagnosis of placenta previa.

Role of ultrasound, Doppler, and MRI in the diagnosis of placenta accreta

Objectives The objectives of this study were to compare the accuracy of ultrasonography and MRI for prenatal diagnosis of placenta accreta (PA) and to compare the sensitivity and specificity of individual ultrasonographic and MRI markers in predicting placental invasion in cases of PA. Background PA is a significant cause of maternal morbidity and mortality, and at present it is the most common reason for emergent postpartum hysterectomy. Placenta previa and previous cesarean section are the two most important known risk factors for PA. Accurate prenatal identification of affected pregnancies allows optimal obstetric management. Ultrasonography still remains the diagnostic standard. However, in recent years, there has been increased interest in MRI in evaluating PA. Patients and methods A combined prospective and retrospective study was carried out on 20 pregnant women with persistent placenta previa (after 28 weeks gestation). All patients were subjected to history taking, complete medical examination, and ultrasound, Doppler, and MRI. Results The sensitivity and specificity of ultrasonography were 63.6 and 91.6%, whereas the sensitivity and specificity of MRI were 72.70 and 100%, respectively, in their ability to diagnose PA. Conclusion MRI hand-in-hand with ultrasound is important for the accurate diagnosis of placenta previa and the serious coexisting PA. Use of both modalities may provide more diagnostic information.

Effect of Primary Elective Cesarean Delivery on Placenta Accreta: A Case-Control Study.

Background:Cesarean section (CS) is an independent risk factor for placenta accreta. Some researchers think that the timing of primary cesarean delivery is associated with placenta accreta in subsequent pregnancies. The aim of this study was to investigate the risk of placenta accreta following primary CS without labor, also called primary elective CS, in a pregnancy complicated with placenta previa.Methods:A retrospective, single-center, case-control study was conducted at Peking University Third Hospital. Relevant clinical data of singleton pregnancies between January 2010 and September 2017 were recorded. The case group included women with placenta accreta who had placenta previa and one previous CS. Control group included women with one previous CS that was complicated with placenta previa. Maternal age, body mass index, gestational age, fetal birth weight, gravity, parity, induced abortion, the rate of women received assisted reproductive technology, other uterine surgery, and primary elective CS were analyzed between the two groups.Results:The rate of primary elective CS (90.1% vs. 69.9%, P < 0.001) was higher, and maternal age was younger (32.7 ± 4.7 years vs. 34.6 ± 4.0 years, P < 0.001) in case group, compared with control group. Case group also had higher gravity and induced abortions compared with the control group (both P < 0.05). Primary CS without labor was associated with significantly increased risk of placenta accreta in a subsequent pregnancy complicated with placenta previa (odds ratio: 3.32; 95% confidential interval: 1.68–6.58).Conclusion:Women with a primary elective CS without labor have a higher chance of developing an accreta in a subsequent pregnancy that is complicated with placenta previa.

Histological and histopathological study of the lower uterine segment after previous caesarean section and placenta accreta

Although the risk factors for placenta accreta are well established, the underlying mechanisms leading to abnormal placental adhesions are less well understood. This study was undertaken to evaluate the histology and histopathology of the lower uterine segment in CS in a trial to understand the possible pathogenesis of placenta accreta.

Outcome of Patients with Placenta Accreta at El Shatby Maternity University Hospital

Objective: The aim of this study was to determine the incidence, risk factors, and outcomes of management of patients with placenta accreta. Background Placenta accreta occurs when the placental implantation is abnormal. The marked increase in incidence has been attributed to the increasing prevalence of cesarean delivery in recent years. The most common theory is defective decidualization. The most important risk factor for placenta accreta is placenta previa after a prior cesarean delivery. The first clinical manifestation of placenta accreta is usually profuse, life-threatening hemorrhage. The recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ. Patients and methods: It’s a study of all cases of placenta accreta at El-Shatby Maternity University Hospital starting from 1/4/2016 till 1/10/2016. Selection of the cases will only be dependent upon their pregnancy gestational age above 28 weeks of gestation. Results: The incidence of placenta accreta was 1/75 cesarean deliveries. The ultrasonography and doppler had a false negative rate of 54.6% and a sensitivity of 45.2% in diagnosis of placenta accreta. The rate of blood transfusion was 79.6%. Uterine preserving procedures performed in 66%. Cesarean hysterectomy performed in 34%. Intensive care unit admission occurred in 27.3%. The mean gestational age at delivery was 33.8 ± 4.6 weeks’ gestation. 31.8% admitted to the neonatal intensive care unit. Conclusion: The incidence of placenta accreta increased due to the increasing rate of cesarean deliveries, prenatal diagnosis of placenta accreta is paramount, as most women are asymptomatic. Prenatal diagnosis allows time for a multidisciplinary team to make delivery plans, which will help decrease surgical complications.

EP14.03: Ultrasound diagnosis and evaluation of the number of prior Caesarean deliveries as risk factor for placenta accreta in placenta previa cases

EP14.03: Ultrasound diagnosis and evaluation of the number of prior Caesarean deliveries as risk factor for placenta accreta in placenta previa cases

Bilateral Absence of Common Iliac Artery: Abnormal anatomical variation of the Internal Iliac Artery During Ligation in Conservative Surgical Management of Placenta Previa Accreta

Abnormal placental invasion has increased with persistent rise in cesarean delivery. Management depends on accurate diagnosis, and delivery should be planned at an institution with appropriate expertise and resources. Hemorrhage in pregnancy is the leading cause of maternal mortality in developing countries. Internal iliac artery ligation is one of the lifesaving procedures in intractable pelvic hemorrhage. The vascular malformations involving the abdominal aorta, common iliac artery and its branches are very rare. We present a case of placenta accreta which is a major risk for peripartum deaths. In this case, we tried to explain our conservative surgical approach in the form of cervico-isthmical transverse opposition suture with bilateral internal iliac artery ligation. Normally, the abdominal aorta bifurcates into the right and left common iliac arteries anterolateral to the fourth lumbar vertebra. In the present case, there was bilateral absence of common iliac arteries which are the terminal branches of the abdominal aorta. Internal iliac artery was extremely long and equal size to external one. The reason for the absence of common iliac artery may be attributed to the disappearance of the initial segment of the umbilical artery. Cesarean section and placenta previa are significant risk factors for placenta accreta which is associated with high fetomaternal morbidity and mortality. In order to avoid postpartum hemorrhage and fertility loosing hysterectomy, our approach which consists of bilateral hypogastric arterial ligation and transverse compression sutures in the lower uterine segment can be applied successfully. Proper identification of anatomical variations in pelvic vasculature is essential for surgical and radiological interventions to prevent complications. This article aims at sharing author’s experience about the anatomical variation of the artery especially long ones as in absent common iliac artery or even a high bifurcation.

Plasenta yapışma anomalileri: Klinik yaklaşım ve yönetim

Obstetric risks have increased among pregnancies following previous cesarean section deliveries. Placenta accreta and cesarean scar pregnancies, as abnormal placentation entities, represent two important clinical manifestations. Placenta accreta is characterised with a placenta that is abnormally adherent to uterine cavity because of the absence of decidua basalis and presence of incompletely developed fibrinoid layer. Placenta accreta occurs in 5-10% of pregnancies complicated with placenta previa. Placenta increta and percreta are the other serious abnormalities of placental implantation that demonstrates invasion of chorionic villi into the myometrium and uterine serosa respectively. Placenta accreta has been seen rarely as 1 in 30.000 births in 1950’s but the incidence of placenta accreta has increased recently to 1 in 553 and 2510 deliveries in parallel with increased cesarean sectio deliveries. Previous uterine surgery is the most important risk factor for placenta accreta. Thin, defectively formed or absent decidua basalis layer can not show resistance to deep penetration of trophoblasts and placenta invades this pathological region of uterus that has previously been traumatised by uterine surgery. Abnormal placental implantation impedes placental removal spontaneously following delivery. The first clinical sign of placenta accreta is profuse and life threatening bleeding that occurs during manuel removal of placenta. Placenta accreta is diagnosed with characteristic signs during prenatal ultrasound examination including color doppler modalities. Magnetic resonance imaging is also helpful for equivocal cases. Massive bleeding and resultant disseminated intravascular coagulation, adult respiratuar distress syndrome, renal insufficiency, unplanned surgery and death are serious complications of placenta accreta. Preoperative and intraoperative management strategies of placenta accreta have been detailed in this review.

Risk Factors for Placenta Accreta: A Large Prospective Cohort

Placenta previa and prior cesarean delivery are known risk factors for placenta accreta. However, other risk factors have not been identified. Our objective was to examine risk factors for accreta using data collected prospectively in a large multicenter cohort. Secondary analysis of women with accreta compared to those without accreta in a large multicenter cesarean delivery cohort. Potential accreta risk factors were examined by univariate and multivariate analyses. In this study, 196 of 73,257 (0.27%) cesarean deliveries were complicated by accreta. As expected, women with increasing numbers of prior cesareans were more likely to have an accreta (p < 0.001), as were women with previa (adjusted odds ratio [OR], 34.9; 95% confidence interval [CI], 22.4-54.3). We also considered only patients with previa and examined the following variables: maternal demographics, prior cesareans, interval between deliveries, parity, body mass index, tobacco use, and coexisting hypertension or diabetes. In this model, patients with previa and two or three prior cesarean deliveries had an adjusted OR for accreta of 4.9 (95% CI, 1.7-14.3) or 7.7 (95% CI, 2.4-24.9), respectively. However, no other variables were significantly associated with accreta. Patients with previa have increased risk for accreta that increases with the number of prior cesarean deliveries. However, no other maternal characteristics were associated with accreta.

Outcomes of prospectively-collected consecutive cases of antenatal-suspected placenta accreta

BackgroundAccurate diagnosis of placenta accreta is tentative before surgery. This study developed a predictive score for antenatal diagnosis of placenta accreta through mathematical modeling using clinical signs. MethodsAntenatal cases of suspected placenta accreta were collected prospectively in a single-site tertiary delivery center. Women with clinical signs of placenta accreta (placenta previa, number of previous cesarean deliveries and/or ultrasound suspicion of placenta accreta) were included. The diagnosis of accreta was confirmed surgically. The primary endpoint was the proportion of surgically-diagnosed placenta accreta among all suspected cases. Logistic regression modeling was performed to assess preoperative risk factors for placenta accreta. The risk score was tested on a receiver operator characteristic curve to identify subjects with placenta accreta and the optimum cut-point was chosen. ResultsOver nine years, 92 suspected accreta cases were identified from 46623 deliveries (0.2%). The diagnosis was confirmed at surgery in 52/92 cases (56%) and there were no maternal deaths. Blood transfusion requirements were greater in patients with placenta accreta versus patients without placenta accreta (median 7 [range 0–25, interquartile range 3–10] versus 0 [0–6, 0–2] units of blood, P <0.0001). Area under the curve of the receiver operator characteristic curve was 0.846, with contribution from three variables (placenta previa, number of previous cesarean deliveries and ultrasound suspicion), each with a P value <0.05. From the ROC curve a cut-point with 100% sensitivity and specificity 25% (95% CI 12.69%–41.20%) was achieved, compared with 86.6% sensitivity (95% CI 74.21%–94.41%) and 60.0% specificity (95% CI 43.33%–75.14%) using ultrasound alone. ConclusionsCombining diagnostic features associated with placenta accreta through mathematical modeling has better positive predictive value than ultrasound alone.