Diagnosis and Management of Placenta Percreta: A Review:

Evaluation of the diagnostic accuracy of a combination of first-trimester ultrasound and maternal demographic characteristics for detecting abnormally invasive placenta

OBJECTIVE

The aim of present study was to evaluate the diagnostic accuracy of using a combination of a first-trimester ultrasound and the maternal demographic characteristics in detecting abnormally invasive placenta (AIP).

STUDY DESIGN

This prospective case-control study comprised 540 women who meet the inclusion criteria and who were included in the final analysis. Patients scored points based on a range between 0 and 13 for the ultrasonographic and clinical findings within first trimester. The primary outcome of the study was whether placenta accreta, increta, and percreta could be predicted early in pregnancy.

RESULTS

The cutoff value of 5.5 provided a sensitivity of 100% and a specificity of 88% and the diagnostic odds ratio (DOR at 95% confidence interval [CI]) was 208 (12-3543), at 95%CI) was 0, and the positive likelihood ratio (LR + at 95%CI) was 8.25 for placenta percreta. The cutoff value of 6.5 provided a sensitivity of 92% and a specificity of 93% and DOR at 95%CI was 201.5 (25.5-1583.1), LR- at 95%CI was 0.08, and LR + at 95%CI was 15.32 for placenta percreta. The cutoff value of 4.5 provided a sensitivity of 100% and a specificity of 90% and DOR at 95%CI was 615 (37-10207), LR- at 95%CI was 0, and LR + at 95%CI was 11.7 for accreta and increta, respectively. The cutoff value of 5.5 provided a sensitivity of 87% and a specificity of 92% and DOR at 95%CI was 86.8 (28.9-260.8), LR- at 95%CI was 0.14, and LR + at 95%CI was 11.7 for placenta accreta and increta, respectively.

CONCLUSION

The results of the present study indicated that this novel scoring provided high diagnostic accuracy for detecting all types of AIP during the first trimester.

Resuscitative endovascular balloon occlusion of the aorta deployed by acute care surgeons in patients with morbidly adherent placenta: a feasible solution for two lives in peril

Morbidly adherent placenta (MAP), which includes accreta, increta, and percreta, is a condition characterized by the invasion of the uterine wall by placental tissue. The condition is associated with higher odds of massive post-partum hemorrhage. Several interventions have been developed to improve hemorrhage-related outcomes in these patients; however, there is no evidence to prefer any intervention over another. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular intervention that may be useful and effective to reduce hemorrhage and transfusions in MAP patients. The objective of this narrative review is to summarize the evidence for REBOA in patients with MAP. We posit that acute care surgeons can perform REBOA for patients with MAP.