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A scoring system to predict the placenta accreta spectrum: a prospective study

Yıl 2023, Cilt: 48 Sayı: 3, 1016 - 1023, 30.09.2023
https://doi.org/10.17826/cumj.1347538

Öz

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.

Kaynakça

  • Maynard H, Zamudio S, Jauniaux E, Collins SL. The importance of bladder volume in the ultrasound diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2018;140:332-37.
  • Fratelli N, Fichera A, Prefumo F. An update of diagnostic efficacy of ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders. Curr Opin Obstet Gynecol. 2022;34:287-91.
  • Einerson BD, Gilner JB, Zuckerwise LC. Placenta accreta spectrum. Obstet Gynecol. 2023;142:31-50.
  • Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018;218:75-87.
  • Goh WA, Zalud I. Placenta accreta: diagnosis, management and the molecular biology of the morbidly adherent placenta. J Matern Fetal Neonatal Med. 2016;29:1795-800.
  • Arakaza A, Zou L, Zhu J. Placenta accreta spectrum diagnosis challenges and controversies in current obstetrics: a review. Int J Womens Health. 2023;15:635-54.
  • Conturie CL, Lyell DJ. Prenatal diagnosis of placenta accreta spectrum. Curr Opin Obstet Gynecol. 2022;34:90-9.
  • Rac MW, Dashe JS, Wells CE, Moschos E, McIntire DD, Twickler DM. Ultrasound predictors of placental invasion: the Placenta Accreta Index. Am J Obstet Gynecol. 2015;212:343.e1-7.
  • Pilloni E, Alemanno MG, Gaglioti P, Sciarrone A, Garofalo A, Biolcati M et al. Accuracy of ultrasound in antenatal diagnosis of placental attachment disorders. Ultrasound Obstet Gynecol. 2016;47:302-7.
  • Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126:654-68.
  • Luo L, Sun Q, Ying D, Wu X, Yan P, Yang Y et al. Scoring system for the prediction of the severity of placenta accrete spectrum in women with placenta previa: a prospective observational study. Arch Gynecol Obstet. 2019;300:783-91.
  • Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med. 1992;11:333-43.
  • Yang JI, Lim YK, Kim HS, Chang KH, Lee JP, Ryu HS. Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section. Ultrasound Obstet Gynecol. 2006;28:178-82.
  • Bhide A, Sebire N, Abuhamad A, Acharya G, Silver R. Morbidly adherent placenta: the need for standardization. Ultrasound Obstet Gynecol. 2017;49:559-63.
  • Tovbin J, Melcer Y, Shor S, Pekar-Zlotin M, Mendlovic S, Svirsky R et al. Prediction of morbidly adherent placenta using a scoring system. Ultrasound Obstet Gynecol. 2016;48:504-10.
  • Agarwal S, Agarwal A, Chandak S. Role of placenta accreta index in prediction of morbidly adherent placenta: A reliability study. Ultrasound. 2021;29:92-9.
  • Sanders TK, Stewart JK. Placenta Accreta Spectrum: The Role of Interventional Radiology in Multidisciplinary Management. Semin Intervent Radiol. 2023;40:349-56.
  • Chong Y, Zhang A, Wang Y, Chen Y, Zhao Y. An ultrasonic scoring system to predict the prognosis of placenta accreta: A prospective cohort study. Medicine (Baltimore). 2018;97:e12111.
  • Stănculescu RV, Brătilă E, Socolov DG, Russu MC, Bauşic V, Chirculescu R et al. Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam - literature review and authors' experience. Rom J Morphol Embryol. 2022;63:293-305.
  • Adu-Bredu TK, Rijken MJ, Nieto-Calvache AJ, Stefanovic V, Aryananda RA, Fox KA et al. A simple guide to ultrasound screening for placenta accreta spectrum for improving detection and optimizing management in resource limited settings. Int J Gynaecol Obstet. 2023;160:732-41.
  • Zosmer N, Jauniaux E, Bunce C, Panaiotova J, Shaikh H, Nicholaides KH. Interobserver agreement on standardized ultrasound and histopathologic signs for the prenatal diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2018;140:326-31.
  • Skupski DW, Duzyj CM, Scholl J, erez-Delboy A, Ruhstaller K, Plante LA et al. Evaluation of classic and novel ultrasound signs of placenta accreta spectrum. Ultrasound Obstet Gynecol. 2022;59:465-73.
  • Collins SL, Alemdar B, van Beekhuizen HJ, Bertholdt C, Braun T, Calda P et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 06 2019;220:511-26.
  • De Oliveira Carniello M, Oliveira Brito LG, Sarian LO, Bennini JR. Diagnosis of placenta accreta spectrum in high-risk women using ultrasonography or magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2022;59:428-36.
  • Marsoosi V, Ghotbizadeh F, Hashemi N, Molaei B. Development of a scoring system for prediction of placenta accreta and determine the accuracy of its results. J Matern Fetal Neonatal Med. 2020;33:1824-30.
  • Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126:654-68.

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

Yıl 2023, Cilt: 48 Sayı: 3, 1016 - 1023, 30.09.2023
https://doi.org/10.17826/cumj.1347538

Öz

Amaç: Çalışmamızın amacı, plasenta akreta spektrumu (PAS) şüphesinde, seçilmiş ultrasonografik özellikleri kullanan skorlama sisteminin, PAS ve ciddiyetini tahmin etmedeki rolünü değerlendirmektir.
Gereç ve Yöntem: Bu prospektif çalışma Temmuz 2019 ile Ocak 2020 tarihleri arasında, 24-37. gebelik haftalarında PAS şüphesi olan plasenta previa totalis tanılı toplam 27 gebe ile gerçekleştirildi. PAS skoru şu parametrelerle hesaplandı: berrak zon kaybı, plasental lakünlerin sayı, boyutu ve düzenliliği, lakün içinde türbülans akım, uterovezikal veya subplasental hipervaskülarite, köprü damarlar ve önceki sezaryen sayısı. Hastalar PAS skorları ve PAS şiddetine göre gruplara ayrıldı. PAS skorlama sisteminin performansı ROC (Receiver Operating Characteristic) eğrileri değerlendirildi.
Bulgular: Toplam 27 hastadan, 7 (%25,9) hastada PAS saptanmadı, 5 (%18,5) hastada akreta, 7 (%25,9) hastada inkreta ve 8 (%29,6) hastada perkreta saptandı. PAS skoru 8'in üzerinde olan grupta, hastaların %86'sında plasenta perkreta mevcuttu. PAS skorları, PAS saptanmayan grupta 2,8±1,4, akreta grubunda 3,6±1,9, inkreta grubunda 5,1±2,4, perkreta grubunda 9,8±1,6 olup perkreta grupbunda istatistiksel olarak daha yüksekti. Anormal plasental invazyonunu öngörmek için optimal PAS skoru 4,5 (%60 duyarlılık, %86 özgüllük), perkretanın inkretadan ayrımında optimal PAS skoru 7,5 (%87,5 duyarlılık, %75 özgüllük) saptandı.
Sonuç: Çeşitli ultrason ve klinik özellikleri kombine eden PAS skorlama sistemi, prenatal risk değerlendirmesini ve PAS prediksiyonunu büyük ölçüde iyileştirebilir.

Kaynakça

  • Maynard H, Zamudio S, Jauniaux E, Collins SL. The importance of bladder volume in the ultrasound diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2018;140:332-37.
  • Fratelli N, Fichera A, Prefumo F. An update of diagnostic efficacy of ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders. Curr Opin Obstet Gynecol. 2022;34:287-91.
  • Einerson BD, Gilner JB, Zuckerwise LC. Placenta accreta spectrum. Obstet Gynecol. 2023;142:31-50.
  • Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018;218:75-87.
  • Goh WA, Zalud I. Placenta accreta: diagnosis, management and the molecular biology of the morbidly adherent placenta. J Matern Fetal Neonatal Med. 2016;29:1795-800.
  • Arakaza A, Zou L, Zhu J. Placenta accreta spectrum diagnosis challenges and controversies in current obstetrics: a review. Int J Womens Health. 2023;15:635-54.
  • Conturie CL, Lyell DJ. Prenatal diagnosis of placenta accreta spectrum. Curr Opin Obstet Gynecol. 2022;34:90-9.
  • Rac MW, Dashe JS, Wells CE, Moschos E, McIntire DD, Twickler DM. Ultrasound predictors of placental invasion: the Placenta Accreta Index. Am J Obstet Gynecol. 2015;212:343.e1-7.
  • Pilloni E, Alemanno MG, Gaglioti P, Sciarrone A, Garofalo A, Biolcati M et al. Accuracy of ultrasound in antenatal diagnosis of placental attachment disorders. Ultrasound Obstet Gynecol. 2016;47:302-7.
  • Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126:654-68.
  • Luo L, Sun Q, Ying D, Wu X, Yan P, Yang Y et al. Scoring system for the prediction of the severity of placenta accrete spectrum in women with placenta previa: a prospective observational study. Arch Gynecol Obstet. 2019;300:783-91.
  • Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med. 1992;11:333-43.
  • Yang JI, Lim YK, Kim HS, Chang KH, Lee JP, Ryu HS. Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section. Ultrasound Obstet Gynecol. 2006;28:178-82.
  • Bhide A, Sebire N, Abuhamad A, Acharya G, Silver R. Morbidly adherent placenta: the need for standardization. Ultrasound Obstet Gynecol. 2017;49:559-63.
  • Tovbin J, Melcer Y, Shor S, Pekar-Zlotin M, Mendlovic S, Svirsky R et al. Prediction of morbidly adherent placenta using a scoring system. Ultrasound Obstet Gynecol. 2016;48:504-10.
  • Agarwal S, Agarwal A, Chandak S. Role of placenta accreta index in prediction of morbidly adherent placenta: A reliability study. Ultrasound. 2021;29:92-9.
  • Sanders TK, Stewart JK. Placenta Accreta Spectrum: The Role of Interventional Radiology in Multidisciplinary Management. Semin Intervent Radiol. 2023;40:349-56.
  • Chong Y, Zhang A, Wang Y, Chen Y, Zhao Y. An ultrasonic scoring system to predict the prognosis of placenta accreta: A prospective cohort study. Medicine (Baltimore). 2018;97:e12111.
  • Stănculescu RV, Brătilă E, Socolov DG, Russu MC, Bauşic V, Chirculescu R et al. Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam - literature review and authors' experience. Rom J Morphol Embryol. 2022;63:293-305.
  • Adu-Bredu TK, Rijken MJ, Nieto-Calvache AJ, Stefanovic V, Aryananda RA, Fox KA et al. A simple guide to ultrasound screening for placenta accreta spectrum for improving detection and optimizing management in resource limited settings. Int J Gynaecol Obstet. 2023;160:732-41.
  • Zosmer N, Jauniaux E, Bunce C, Panaiotova J, Shaikh H, Nicholaides KH. Interobserver agreement on standardized ultrasound and histopathologic signs for the prenatal diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2018;140:326-31.
  • Skupski DW, Duzyj CM, Scholl J, erez-Delboy A, Ruhstaller K, Plante LA et al. Evaluation of classic and novel ultrasound signs of placenta accreta spectrum. Ultrasound Obstet Gynecol. 2022;59:465-73.
  • Collins SL, Alemdar B, van Beekhuizen HJ, Bertholdt C, Braun T, Calda P et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 06 2019;220:511-26.
  • De Oliveira Carniello M, Oliveira Brito LG, Sarian LO, Bennini JR. Diagnosis of placenta accreta spectrum in high-risk women using ultrasonography or magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2022;59:428-36.
  • Marsoosi V, Ghotbizadeh F, Hashemi N, Molaei B. Development of a scoring system for prediction of placenta accreta and determine the accuracy of its results. J Matern Fetal Neonatal Med. 2020;33:1824-30.
  • Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126:654-68.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kadın Hastalıkları ve Doğum
Bölüm Araştırma
Yazarlar

Merve Öztürk Ağaoğlu 0000-0002-1283-4032

Ali Çağlar 0000-0002-7022-3029

Erken Görünüm Tarihi 26 Eylül 2023
Yayımlanma Tarihi 30 Eylül 2023
Kabul Tarihi 11 Eylül 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 48 Sayı: 3

Kaynak Göster

MLA Öztürk Ağaoğlu, Merve ve Ali Çağlar. “A Scoring System to Predict the Placenta Accreta Spectrum: A Prospective Study”. Cukurova Medical Journal, c. 48, sy. 3, 2023, ss. 1016-23, doi:10.17826/cumj.1347538.