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Kang Y, Zhong Y, Qian W, Yue Y, Peng L. A prediction model based on MRI and ultrasound to predict the risk of PAS in patient with placenta previa. Eur J Obstet Gynecol Reprod Biol 2024; 301:227-233. [PMID: 39159508 DOI: 10.1016/j.ejogrb.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION To investigate the risk factors affecting patients with placenta previa (PP) and to construct an effective prediction model for the severity of PAS in PP. METHODS A total of 240 pregnant women with PP were enrolled in this study. An MRI+Ultrasound-based model was developed to classify patients into placental implantation and non-placental implantation groups. Multivariate nomograms were created based on imaging features. The model was evaluated using Receiver Operating Characteristic (ROC) curve analysis. The predictive accuracy of the nomogram was assessed through calibration plots and decision curve analysis. RESULTS The MRI+Ultrasound-based prediction model demonstrated favorable discrimination between the placental implantation and non-placental implantation groups. The calibration curve exhibited agreement between the estimated and actual probability of placental implantation. Additionally, decision curve analysis indicated a high clinical benefit across a wide range of probability thresholds. The Area under the ROC curve (AUC) was 0.911 (95 % CI: 0.76-0.947), with a sensitivity of 88.40 % and specificity of 88.10 %. CONCLUSION The MRI+Ultrasound-based prediction model could be a valuable tool for preoperative prediction of the percentage of implantation. Our study enables obstetricians to conduct more adequate preoperative evaluations.
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Affiliation(s)
- Yan Kang
- Department of Obstetrics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Yun Zhong
- Department of Obstetrics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Weiliang Qian
- Department of Imaging, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hosipital, Suzhou, China
| | - Yongfei Yue
- Department of Obstetrics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Lan Peng
- Department of Obstetrics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China.
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Agarwal N, Hernandez-Andrade E, Sibai BM, Amro FH, Coselli JO, Bartal MF, Lai D, Torres EES, Backley S, Johnson A, Espinoza J, Bergh EP, Zhu S, Salazar A, Blackwell SC, Papanna R. Quantifying placenta accreta spectrum severity and its associated blood loss: a novel transvaginal ultrasound scoring system. Am J Obstet Gynecol MFM 2024; 6:101451. [PMID: 39096965 DOI: 10.1016/j.ajogmf.2024.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/21/2024] [Accepted: 07/13/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Hemorrhage associated with placenta accreta spectrum (PAS) is a leading cause of maternal morbidity and mortality. Estimating blood loss in these individuals is a critical component of comprehensive preoperative planning. OBJECTIVE A semiquantitative score based on transvaginal ultrasound was developed and tested to predict PAS, estimate its severity, and blood loss in individuals with clinical and ultrasound evidence suggesting PAS. STUDY DESIGN A secondary analysis was conducted of prospectively collected data from a quaternary center of patients with suspected accreta on 2D ultrasound and clinical suspicion. A predetermined scoring system was applied based on three components: (1) uterine wall (score 0: no loss of hypo-translucent uterine wall with overlying placenta in the lower uterine segment; 1: loss of hypo-translucent <3-cm defect; 2: 3-6-cm defect; and 3: >6-cm defect); (2) arterial vascularity at the uterine wall defect (score 0: no vessels observed; 1: 1-2 vessels over the defect; 2: 3-5 vessels; and 3: >5 vessels); and (3) cervical involvement (score 0: normal cervical length without previa; 1: previa with normal cervical length; 2: short cervix with previa, minimal vascularity and small lacunae; 3: short cervix with previa, increased vascularity and large lacunae). Each patient's three domain scores determined a cumulative, final score of 0-9. Patients were managed at the discretion of a multi-disciplinary team and patient's preference among the following options: cesarean delivery with placenta removal, cesarean delivery with placenta in-situ (conservative) with or without delayed hysterectomy, or cesarean hysterectomy. The frequency of different degrees of placental invasion per pathology examination per score unit was registered. Multiple linear regression analysis was performed for association of blood loss according to score adjusted by risk factors for PAS. RESULTS A total of 73 patients were evaluated. All 11 patients who had a score of 0 had cesarean delivery with placenta removal without evidence of intraoperative PAS, thus resulting in a 100% negative predictive value. The remaining 62 had scores between 1 and 9. Among patients with scores 0-3 (n=20), only one had intraoperative PAS, yielding a negative predictive value of 97%. Higher scores were associated with severe PAS forms (r=0.301, P=.02). Based on the associations between PAS scores, clinical correlation, and blood loss, we divided patients into four categories: Category 0: PAS score 0; Category 1: scores 1-3; Category 2: scores 4-6; and Category 3: scores 7-9. The median blood loss in Category 0=635±352 mL, Category 1=634±599 mL, Category 2=1549±1284 mL, and Category 3=1895±2106 mL (P<.001). On multivariable analysis, Category 2 (β=0.97, P<.01) and Category 3 (β=1.26, P<.003) were associated with significantly greater blood loss than Category 0, irrespective of type of surgery. CONCLUSION The transvaginal ultrasound score separates groups at low risk (Category 0) and at higher risk of PAS (Categories 1-3). Categories 1-3 may provide important clinical information to estimate the risk of severe forms of PAS and of blood loss during surgery. VIDEO ABSTRACT.
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Affiliation(s)
- Neha Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Agarwal, Hernandez-Andrade, Backley, Johnson, Espinoza, Bergh, Zhu, Salazar, and Papanna)
| | - Edgar Hernandez-Andrade
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Agarwal, Hernandez-Andrade, Backley, Johnson, Espinoza, Bergh, Zhu, Salazar, and Papanna)
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Sibai, Amro, Coselli, Bartal, Torres, and Blackwell)
| | - Farah H Amro
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Sibai, Amro, Coselli, Bartal, Torres, and Blackwell)
| | - Jennie O Coselli
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Sibai, Amro, Coselli, Bartal, Torres, and Blackwell)
| | - Michal F Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Sibai, Amro, Coselli, Bartal, Torres, and Blackwell)
| | - Dejian Lai
- Department of Biostatistics, UTHealth School of Public Health, Houston, TX (Lai)
| | - Eleazar E Soto Torres
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Sibai, Amro, Coselli, Bartal, Torres, and Blackwell)
| | - Sami Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Agarwal, Hernandez-Andrade, Backley, Johnson, Espinoza, Bergh, Zhu, Salazar, and Papanna)
| | - Anthony Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Agarwal, Hernandez-Andrade, Backley, Johnson, Espinoza, Bergh, Zhu, Salazar, and Papanna)
| | - Jimmy Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Agarwal, Hernandez-Andrade, Backley, Johnson, Espinoza, Bergh, Zhu, Salazar, and Papanna)
| | - Eric P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Agarwal, Hernandez-Andrade, Backley, Johnson, Espinoza, Bergh, Zhu, Salazar, and Papanna)
| | - Sen Zhu
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Agarwal, Hernandez-Andrade, Backley, Johnson, Espinoza, Bergh, Zhu, Salazar, and Papanna)
| | - Ashley Salazar
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Agarwal, Hernandez-Andrade, Backley, Johnson, Espinoza, Bergh, Zhu, Salazar, and Papanna)
| | - Sean C Blackwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Sibai, Amro, Coselli, Bartal, Torres, and Blackwell)
| | - Ramesha Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX (Agarwal, Hernandez-Andrade, Backley, Johnson, Espinoza, Bergh, Zhu, Salazar, and Papanna).
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Pekar Zlotin M, Sharabi-Nov A, Meiri H, Revivo PE, Melcer Y, Maymon R, Jauniaux E. Clinical-sonographic scores for the screening of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2024; 6:101369. [PMID: 38636601 DOI: 10.1016/j.ajogmf.2024.101369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Clinical-sonographic scoring systems combining clinical features and ultrasound imaging markers have been proposed for the screening of placenta accreta spectrum, but their usefulness in different settings remains limited. This study aimed to assess and compare different clinical-sonographic score systems applied from mid-pregnancy for the prenatal evaluation of patients at risk of placenta accreta spectrum at birth. DATA SOURCES PubMed/MEDLINE, Google Scholar, and Embase were searched between October 1982 and October 2022 to identify eligible studies. STUDY ELIGIBILITY CRITERIA Observational studies providing data on the use of a combined clinical-ultrasound score system applied from mid-pregnancy for the prenatal evaluation of placenta accreta spectrum were included. METHODS Study characteristics were evaluated by 2 independent reviewers using a predesigned protocol registered on PROSPERO (CRD42022332486). Heterogeneity among studies was analyzed with Cochran's Q-test and I2 statistics. Statistical heterogeneity was quantified by estimating the variance between the studies using I2 statistics. The area under the receiver operating characteristic curve of each score and their summary receiver operating characteristic curves were calculated with sensitivity and specificity, and the integrated score of the summaries of the receiver operating characteristic curves of all sonographic markers was calculated. Forest plots were used to develop the meta-analysis of each sonographic marker and for the integrated sonographic score. RESULTS Of 1028 articles reviewed, 12 cohorts and 2 case-control studies including 1630 patients screened for placenta accreta spectrum by clinical-ultrasound scores met the eligibility criteria. A diagnosis of placenta accreta spectrum was reported in 602 (36.9%) cases, for which 547 (90.9%) intraoperative findings and/or histopathologic data were described. A wide variation was observed among the studies in reported sensitivities and specificities and in thresholds used for the identification of patients with a high probability of placenta accreta spectrum at birth. The summaries of the areas under the curve of the individual sonographic scores ranged from 0.85 (the lowest) for subplacental hypervascularity to 0.91 for placental location in the lower uterine segment, myometrial thinning, and placental lacunae and 0.95 for the loss of clear zone. Only 4 studies included placental bulging in their sonographic score system, and therefore no meta-analysis for this score was performed. The integrated summary of the areas under the curve was 0.83 (95% confidence interval, 79-0.86). Forest plot analysis revealed integrated sensitivities and specificities of 0.68 (95% confidence interval, 0.53-0.80) and 0.88 (95% confidence interval, 0.68-0.96), respectively. CONCLUSION Clinical-sonographic score systems can contribute to the prenatal screening of patients at risk of placenta accreta spectrum at birth. Although we included multiple sonographic studies conducted during the mid-pregnancy period, standardized evaluation should be performed not only with strict ultrasound criteria for the placental position, mid third trimester gestational age at examination, and sonographic markers associated with PAS. Numeric sensitivities, specificities, NPVs, PPV, LR-, and LR+ should be recorded prospectively to assess their accuracy in different set-ups and PTP should be verified at delivery. The variables recommended for most predictive screening are: loss of clear zone underneath the placental bed, placentation in the LUS, and placenta lacunae.
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Affiliation(s)
- Marina Pekar Zlotin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel (Dr Pekar Zlotin, Dr Eliassi Revivo, and Dr Maymon); School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel (Dr Pekar Zlotin, Dr Eliassi Revivo, and Dr Maymon)
| | - Adi Sharabi-Nov
- Department of Statistics, Tel-Hai Academic College, Tel Hai, Israel (Dr Sharabi-Nov); Ziv Medical Center, Safed, Israel (Dr Sharabi-Nov)
| | - Hamutal Meiri
- PreTwin Screen Consortium, Tel Aviv, Israel (Drs Meiri and Melcer); TeleMarpe Ltd, Tel Aviv, Israel(Drs Meiri and Melcer)
| | - Perry Eliassi Revivo
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel (Dr Pekar Zlotin, Dr Eliassi Revivo, and Dr Maymon); School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel (Dr Pekar Zlotin, Dr Eliassi Revivo, and Dr Maymon)
| | - Yakkov Melcer
- PreTwin Screen Consortium, Tel Aviv, Israel (Drs Meiri and Melcer); TeleMarpe Ltd, Tel Aviv, Israel(Drs Meiri and Melcer)
| | - Ron Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel (Dr Pekar Zlotin, Dr Eliassi Revivo, and Dr Maymon); School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel (Dr Pekar Zlotin, Dr Eliassi Revivo, and Dr Maymon).
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, United Kingdom (Dr Jauniaux)
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Adu-Bredu TK, Aryananda RA, Arkorful J, Matthewlynn S, Collins SL. Differentiating placenta accreta spectrum from scar dehiscence with underlying, non-adherent placenta: A systematic review of scoring systems and primary data analysis. Acta Obstet Gynecol Scand 2024. [PMID: 38819580 DOI: 10.1111/aogs.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Accurate discrimination between placenta accreta spectrum (PAS) and scar dehiscence with underlying non-adherent placenta is challenging both on prenatal ultrasound and intraoperatively. This can lead to overdiagnosis of PAS and unnecessarily aggressive management of scar dehiscence which increases the risk of morbidity. Several scoring systems have been published which combine clinical and ultrasound information to help diagnose PAS in women at high risk. This research aims to provide insights into the reliability and utility of existing accreta scoring systems in differentiating these two closely related but different conditions to contribute to improved clinical decision making and patient outcomes. MATERIAL AND METHODS A literature search was performed in four electronic databases. The references of relevant articles were also assessed. The articles were then evaluated according to the predefined inclusion criteria. Primary data for testing each scoring system were obtained retrospectively from two hospitals with specialized PAS services. Each scoring system was used to evaluate the predicted outcome of each case. RESULTS The literature review yielded 15 articles. Of these, eight did not have a clearly described diagnostic criteria for accreta, hence were excluded. Of the remaining seven studies, one was excluded due to unorthodox diagnostic criteria and two were excluded as they differed from the other systems hindering comparison. Four scoring systems were therefore tested with the primary data. All the scoring systems demonstrated higher scores for high-grade PAS compared to scar dehiscence (p < 0.001) with an excellent Area Under the receiver operator characteristic Curve ranging from 0.82 (95% CI 0.71-0.92) to 0.87 (95% CI 0.79-0.96) in differentiating between these two conditions. However, no statistically significant differences were noted between the low-grade PAS and scar dehiscence on all scoring systems. CONCLUSIONS Most published scoring systems have no clearly defined diagnostic criteria. Scoring systems can differentiate between scar dehiscence with underlying non-adherent placenta from high-grade PAS with excellent diagnostic accuracy, but not for low-grade PAS. Hence, relying solely on these scoring systems may lead to errors in estimating the risk or extent of the condition which hinders preoperative planning.
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Affiliation(s)
- Theophilus K Adu-Bredu
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Rozi Aditya Aryananda
- Obstetrics and Gynecology Department, Maternal Fetal Medicine, Dr Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Joseph Arkorful
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana
| | - Sam Matthewlynn
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Sally L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
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Lu Y, Zhou L, Wang X, Li Y, Chen D, Gu Y, Yue Y. Magnetic Resonance Imaging-Based Radiomics Nomogram to Predict Intraoperative Hemorrhage of Placenta Previa. Am J Perinatol 2024; 41:e2174-e2183. [PMID: 37225126 DOI: 10.1055/a-2099-3809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Placenta previa (PP) is associated with intraoperative and postpartum hemorrhage, increased maternal morbidity and mortality. We aimed to develop a magnetic resonance imaging (MRI)-based nomogram to preoperative prediction of intraoperative hemorrhage (IPH) for PP. STUDY DESIGN A total of 125 PP pregnant women were divided into a training set (n = 80) and a validation set (n = 45). An MRI-based model was built for the classification of patients into IPH and non-IPH groups in a training set and a validation set. Multivariate nomograms were built according to radiomics features. Receiver operating characteristic (ROC) curve was used to assess the model. Predictive accuracy of nomogram were assessed by calibration plots and decision curve analysis. RESULTS In multivariate analysis, placenta position, placenta thickness, cervical blood sinus, and placental signals in the cervix were significantly independent predictors for IPH (all ps < 0.05). The MRI-based nomogram showed favorable discrimination between IPH and non-IPH groups. The calibration curve showed good agreement between the estimated and the actual probability of IPH. Decision curve analysis also showed a high clinical benefit across a wide range of probability thresholds. Area under the ROC curve was 0.918 (95% confidence interval [CI]: 0.857-0.979) in the training set and 0.866 (95% CI: 0.748-0.985) in the validation set by the combination of four MRI features. CONCLUSION The MRI-based nomograms might be a useful tool for the preoperative prediction of IPH outcomes for PP. Our study enables obstetricians to perform adequate preoperative evaluation to reduce blood loss and cesarean hysterectomy. KEY POINTS · MRI is an important method for preoperative assessment of the risk of placenta previa.. · MRI-based nomogram can assess the risk of intraoperative bleeding of placenta previa.. · MRI is helpful for more comprehensive evaluation of placenta previa and adequate preoperative preparation..
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Affiliation(s)
- Yanli Lu
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Liping Zhou
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Xiaoyan Wang
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Yongmei Li
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Dali Chen
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Yidong Gu
- Department of Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Yongfei Yue
- Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People's Republic of China
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Wang C, Wang Z. Value of early pregnancy ultrasound combined with ultrasound score in the evaluation of placenta accreta in scar uterus: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e37531. [PMID: 38489684 PMCID: PMC10939536 DOI: 10.1097/md.0000000000037531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
The objective of this study is to investigate the value of early pregnancy ultrasound combined with ultrasound score (USS) for the evaluation of placenta accreta (PA) in scar uteri. Thirty cases of PA in scar uteri diagnosed by ultrasound at our hospital between June 2021 and June 2022 were selected retrospectively (observation group). In addition, 30 patients had placenta attached to the anterior wall of the uterus and covered the internal orifice of the cervix; however, no PA was selected in the same period (control group). The results of surgical pathology and ultrasound examination in the first trimester of pregnancy (11-14 weeks of pregnancy, fetal top hip length 4.5-8.4 cm) were analyzed. Ultrasonic image characteristics of the 2 groups were scored using an ultrasonic scoring scale. The ultrasonic signs and ultrasonic scores of the 2 groups were analyzed. The diagnostic value of ultrasound and USS for PA in the scarred uterus alone and in combination was analyzed based on the gold standard of surgical and pathological results. The rich blood flow signal at the junction of the uterine serosa and bladder, the rate of blood flow in the cavity of the placental parenchyma, the thinning rate of the myometrium after placenta, and the abnormal rate of the low echo area after placenta in the observation group were significantly higher than those in the control group (P < .05). The USS of the observation group was significantly higher than that of the control group (P < .05). The sensitivity (93.33%) and accuracy (95.00%) of the combined examinations were significantly higher than those of ultrasound (70.00% and 83.33%, respectively) (P < .05). The sensitivity and accuracy of combined examination were slightly higher than those of USS examination (83.33% and 90.00%), but the difference was not statistically significant (P > .05). There was no significant difference between the specificity of combined examination (93.33%) and ultrasound (96.67%) and USS (96.67%) (P > .05). Early pregnancy ultrasound and USS evaluation have high application value in the diagnosis and evaluation of early scar uterine PA. The combination of the 2 methods can further improve the sensitivity and accuracy of diagnosis.
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Affiliation(s)
- Cuigai Wang
- Department of Ultrasonography, Hebei reproductive maternity hospital, Shijiazhuang City, Hebei Province, China
| | - Zhiyuan Wang
- Department of Ultrasound, Zhengding County People’s Hospital, Shijiazhuang City, Hebei Province, China
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Zong M, Pei X, Yan K, Luo D, Zhao Y, Wang P, Chen L. Deep Learning Model Based on Multisequence MRI Images for Assessing Adverse Pregnancy Outcome in Placenta Accreta. J Magn Reson Imaging 2024; 59:510-521. [PMID: 37851581 DOI: 10.1002/jmri.29023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Preoperative assessment of adverse outcomes risk in placenta accreta spectrum (PAS) disorders is of high clinical relevance for perioperative management and prognosis. PURPOSE To investigate the association of preoperative MRI multisequence images and adverse pregnancy outcomes by establishing a deep learning model in patients with PAS. STUDY TYPE Retrospective. POPULATION 323 pregnant women (age from 20 to 46, the median age is 33), suspected of PAS, underwent MRI to assess the PAS, divided into the training (N = 227) and validation datasets (N = 96). FIELD STRENGTH/SEQUENCE 1.5T scanner/fast imaging employing steady-state acquisition sequence and single shot fast spin echo sequence. ASSESSMENT Different deep learning models (i.e., with single MRI input sequence/two sequences/multisequence) were compared to assess the risk of adverse pregnancy outcomes, which defined as intraoperative bleeding ≥1500 mL and/or hysterectomy. Net reclassification improvement (NRI) was used for quantitative comparison of assessing adverse pregnancy outcome between different models. STATISTICAL TESTS The AUC, sensitivity, specificity, and accuracy were used for evaluation. The Shapiro-Wilk test and t-test were used. A P value of <0.05 was considered statistically significant. RESULTS 215 cases were invasive placenta accreta (67.44% of them with adverse outcomes) and 108 cases were non-invasive placenta accreta (9.25% of them with adverse outcomes). The model with four sequences assessed adverse pregnancy outcomes with AUC of 0.8792 (95% CI, 0.8645-0.8939), with ACC of 85.93% (95%, 84.43%-87.43%), with SEN of 86.24% (95% CI, 82.46%-90.02%), and with SPC of 85.62% (95%, 82.00%-89.23%) on the test cohort. The performance of model with four sequences improved above 0.10 comparing with that of model with two sequences and above 0.20 comparing with that of model with single sequence in terms of NRI. DATA CONCLUSION The proposed model showed good diagnostic performance for assessing adverse pregnancy outcomes. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ming Zong
- School of Computer Science, Peking University, Beijing, China
| | - Xinlong Pei
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Kun Yan
- School of Computer Science, Peking University, Beijing, China
| | - Deng Luo
- School of Software and Microelectronics, Peking University, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Ping Wang
- School of Software and Microelectronics, Peking University, Beijing, China
- National Engineering Research Center for Software Engineering, Peking University, Beijing, China
- Key Laboratory of High Confidence Software Technologies (Peking University), Ministry of Education, Beijing, China
| | - Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, China
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Zhang J, Li H, Feng D, Wu J, Wang Z, Feng F. Ultrasound scoring system for prenatal diagnosis of placenta accreta spectrum. BMC Pregnancy Childbirth 2023; 23:569. [PMID: 37550654 PMCID: PMC10405485 DOI: 10.1186/s12884-023-05886-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND To develop an ultrasound scoring system for placenta accreta spectrum (PAS), evaluate its diagnostic value, and provide a practical approach to prenatal diagnosis of PAS. METHODS A total of 532 pregnant women (n = 184 no PAS, n = 120 placenta accreta, n = 189 placenta increta, n = 39 placenta percreta) at high-risk for placenta accreta who delivered in the Third Affiliated Hospital of Zhengzhou University between January 2021 and December 2022 underwent prenatal ultrasound to evaluate placental invasion. An ultrasound scoring system that included placental and cervical morphology and history of cesarean section was created. Each feature was assigned a score of 0 ~ 2, according to severity. Thresholds for the total ultrasound score that discriminated between no PAS, placenta accreta, placenta increta, and placenta percreta were calculated. RESULTS Univariate and multivariate regression analysis identified seven indicators of PAS that were included in the ultrasound scoring system, including placental location, placental thickness, presence/absence of the retroplacental space, thickness of the retroplacental myometrium, presence/absence of placental lacunae, retroplacental myometrial blood flow and history of cesarean section. Using the final ultrasound scoring system, no PAS is diagnosed at a total score < 5, placenta accreta or placenta increta is diagnosed at a total score 5-10, and placenta percreta is diagnosed at a total score ≥ 10. CONCLUSIONS This study identified seven indicators of PAS and included them in an ultrasound scoring system that has good diagnostic efficacy and clinical utility. TRIAL REGISTRATION ChiCTR2300069261 (retrospectively registered on 10/03/2023).
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Affiliation(s)
- Junling Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hezhou Li
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Demin Feng
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Wu
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaoyu Wang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fan Feng
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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9
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Maged AM, El-Mazny A, Kamal N, Mahmoud SI, Fouad M, El-Nassery N, Kotb A, Ragab WS, Ogila AI, Metwally AA, Lasheen Y, Fahmy RM, Katta M, Shaeer EK, Salah N. Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:354. [PMID: 37189095 DOI: 10.1186/s12884-023-05675-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS). DATA SOURCES Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis. STUDY ELIGIBILITY CRITERIA All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them. STUDY APPRAISAL AND SYNTHESIS METHODS Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity. RESULTS The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively. CONCLUSIONS The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases. TRIAL REGISTRATION Number CRD42021267501.
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Affiliation(s)
- Ahmed M Maged
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt.
| | - Akmal El-Mazny
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Nada Kamal
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Safaa I Mahmoud
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Mona Fouad
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Noura El-Nassery
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Amal Kotb
- Department of Obstetrics and Gynecology, Beni-Suef University, Beni-Suef, Egypt
| | - Wael S Ragab
- Department of Obstetrics and Gynecology, Fayoum University, Fayoum, Egypt
| | - Asmaa I Ogila
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Ahmed A Metwally
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Yossra Lasheen
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Radwa M Fahmy
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Maha Katta
- Department of Obstetrics and Gynecology, Beni-Suef University, Beni-Suef, Egypt
| | - Eman K Shaeer
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Noha Salah
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
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10
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Yang X, Zheng W, Yan J, Yang H. High Risk Factors for Placenta Accreta Other than Pregnancy and Their Impact on Patient Prognosis. MATERNAL-FETAL MEDICINE 2023. [DOI: 10.1097/fm9.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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11
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Yang X, Zheng W, Yan J, Yang H. Comparison between placenta accreta scoring system, ultrasound staging, and clinical classification. Medicine (Baltimore) 2022; 101:e31622. [PMID: 36401394 PMCID: PMC9678602 DOI: 10.1097/md.0000000000031622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Placenta accreta spectrum (PAS) is a series of disorders, which means that the placental trophoblast invades into the myometrium of the uterine wall. It is a serious obstetric complication which could be detected by ultrasound prenatally. In order to compare our placenta accreta scoring system with prenatal ultrasound staging system and International Federation of Gynecology and Obstetrics (FIGO) clinical classification, we did a retrospective study including 105 patients diagnosed with PAS disorders by operation or pathology at Peking University First Hospital, Beijing, China, between January, 2019 and December, 2020. Placenta accreta scoring system, prenatal ultrasound staging system and FIGO clinical classification were used on each patient. Basic information and clinical outcomes including gestational weeks, intraoperative hemorrhage, hysterectomy rate and blood transfusion were also counted. Both of placenta accreta scoring system, prenatal ultrasound staging system can give a rather clear prediction of placenta percreta, with their area under curve were 0.872 (95% confidential interval [CI]: 0.793-0.951) and 0.864 (95%CI: 0.779-0.949), P value were .000 compared with clinical classification. Beside for ultrasound staging system was designed for placenta previa patients, all those 3 criteria showed their relationships with preterm birth, hysterectomy rate and intraoperative bleeding. PAS scoring system also had the ability to predict a gestational week of delivery ≤34 weeks, intraoperative massive bleeding ≥2000 mL and hysterectomy at over 12 points. Our placenta accreta scoring system had good accordance with pre-operational ultrasound staging and FIGO clinical classification, with higher universality for patients without placenta previa.
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Affiliation(s)
- Xinrui Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Weiran Zheng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Jie Yan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- * Correspondence: Huixia Yang, Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China (e-mail: )
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12
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Huang F, Wang J, Xu Y, Xiong Q, Wang W, Zhuo J, Xia Q, Yang X. Association between cervical length and massive intraoperative bleeding in patients with suspected placenta accreta spectrum combined with placenta previa: A retrospective cohort study. Front Surg 2022; 9:1028494. [PMCID: PMC9634406 DOI: 10.3389/fsurg.2022.1028494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Abnormal placentation is a spectrum disorder that includes creta, increta, and percreta; the term placenta accreta spectrum (PAS) disorders is used as a broad term to describe all of these conditions. PAS can lead to life-threatening hemorrhage. The predictive value of cervical length (CL) in patients with PAS remains controversial. Thus, this study investigated the relationship between CL and the probability of major bleeding in patients with PAS and placenta previa. Methods This retrospective cohort study was conducted at a comprehensive tertiary hospital in Chongqing, China, between January 2018 and December 2020. The target independent and dependent variables were CL and intraoperative massive bleeding, respectively. The covariates included demographic, clinical, and ultrasound characteristics. Logistic regression was used to explore the association between CL and massive bleeding. Results In total, 317 participants were enrolled, in whom the prevalence of massive bleeding was 41.9% (133/317). The threshold of CL associated with massive bleeding (≥1,000 ml) was 33 mm based on a receiver operating characteristic curve. In the fully adjusted model for each additional unit of CL, the risk of massive bleeding decreased by 7% [95% confidence interval (CI), 0.88–0.98]. The risk of major bleeding was reduced by 44% in patients with a CL greater than 33 mm (95% CI, 0.33–0.97) compared with patients with a CL less than 33 mm. Conclusions CL was negatively associated with massive intraoperative bleeding in patients with PAS combined with placenta previa. When the CL was greater than 33 mm, the risk of bleeding decreased by 44%. Thus, CL can be used as a standalone parameter to identify the risk of massive intraoperative bleeding in patients with suspected PAS.
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Affiliation(s)
- Fusen Huang
- Department of Anesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Correspondence: Fusen Huang Jingjie Wang
| | - Jingjie Wang
- Department of Radiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Correspondence: Fusen Huang Jingjie Wang
| | - Yi Xu
- Department of Anesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiuju Xiong
- Department of Anesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjian Wang
- Department of Anesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Zhuo
- Department of Information Center, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiuling Xia
- Department of Obstetrics and Fetal Medicine Unit, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojuan Yang
- Department of Anesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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13
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Watthanasathitnukun W, Pranpanus S, Petpichetchian C. Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder. PLoS One 2022; 17:e0276153. [PMID: 36240191 PMCID: PMC9565412 DOI: 10.1371/journal.pone.0276153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate certain two-dimensional (2D) ultrasound signs as predictors of massive peri-operative blood loss (PBL) in pregnant women with placenta previa suspicious of PAS disorder. MATERIALS AND METHODS A single center retrospective study was done in pregnant women who had undergone prenatal diagnosis with 2D ultrasound grey scale and color Doppler using the EW-AIP (which has been changed to IS-PAS (International Society for the Placenta Accreta Spectrum)) criteria between January 2007 and May 2021. The patients were divided into 2 groups, non-massive hemorrhage with PBL ≤ 2500 mL and massive PBL >2500 mL. All PAS cases had pathological confirmation. Ultrasound signs and hemorrhagic outcomes were compared between the two groups. A PAS scoring system to predict massive PBL was constructed and a receiver operating characteristic (ROC) curve was calculated to evaluate the efficacy of the scoring system. RESULTS Of 534 women, 146 (28.3%) had PBL > 2500 mL and 388 (71.7%) had PBL ≤ 2500 mL. In the massive PBL group, 101 (69.2%) were diagnosed as PAS and 45 (30.8%) as placenta previa alone. From 10 evaluated 2D ultrasound signs, 3 had the highest odds ratios (ORs) associated with massive PBL, 'focal exophytic mass' OR 8.17 (p = 0.024), 'placental bulge' OR 2.47 (p = 0.011), and 'placental lacunae feeder vessels' OR 2.38 (p = 0.01). When using the PAS scoring system, the AUC to predict massive PBL was 0.80 (95% CI, 0.76-0.85,). CONCLUSION Our PAS scoring system based on 2-dimensional ultrasound signs combined with grey scale and color Doppler is useful to predict massive PBL and can help optimize pre-operative management in cases of previa suspicious of PAS.
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Affiliation(s)
- Wattanan Watthanasathitnukun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Savitree Pranpanus
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- * E-mail:
| | - Chusana Petpichetchian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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14
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Huang F, Wang J, Xiong Q, Wang W, Xu Y, Zhuo J, Xia Q, Liu X. Association of the placenta accreta spectrum score and estimated blood loss in placenta accreta spectrum patients with placenta previa: a retrospective cohort study. J Anesth 2022; 36:715-722. [PMID: 36173551 DOI: 10.1007/s00540-022-03108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The placenta accreta spectrum (PAS) score calculated by the scoring system may predict patients with PAS. We aim to find the relationship between estimated blood loss and the PAS score. Further, find the inflection point, identify PAS patients with placenta previa who were at risk for major bleeding. METHODS The PAS patients with placenta previa, as diagnosed by color Doppler ultrasound, were divided into two groups according to their PAS scores using a new scoring system. Blood loss, transfusion requirements, the rate of Intra-Abdominal Balloon Occlusion (IABO), and other indicators were analyzed between groups. RESULTS The estimated blood loss, intraoperative transfusion, postoperative transfusion, operation time, and hospitalization time significantly increased in the group with a PAS score ≥ 9 (P < 0.05). The inflection point analysis revealed that a significant increase in estimated blood loss occurred when the PAS score was beyond 10 (crude) or 6 (adjusted for age, body mass index, and IABO). CONCLUSION There was a non-linear relationship between estimated intraoperative blood loss and PAS score. When the PAS score was greater than 9, hemorrhage, the risk of major bleeding, the need for transfusions, and the placement of an abdominal aortic balloon all increase significantly.
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Affiliation(s)
- Fusen Huang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China.
| | - Jingjie Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qiuju Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China.
| | - Wenjian Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Yi Xu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Jia Zhuo
- Department of Information Center, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Qiuling Xia
- Department of Obstetrics and Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Xiaonan Liu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
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15
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Zhou Y, Song Z, Wang X, Zhang M, Chen X, Zhang D. Ultrasound-based nomogram for postpartum hemorrhage prediction in pernicious placenta previa. Front Physiol 2022; 13:982080. [PMID: 36072853 PMCID: PMC9441797 DOI: 10.3389/fphys.2022.982080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Pernicious placenta previa (PPP) is one of the most dangerous complications in pregnancy after cesarean section, with high perinatal mortality. This study aimed to develop a nomogram to predict postpartum hemorrhage in patients with PPP. Methods: A total of 246 patients with confirmed PPP at Shengjing Hospital of China Medical University from January 2018 to December 2021 were included. Patients were divided into to two cohorts depending on a postpartum blood loss of > 1000 ml (n = 146) or ≤ 1000 ml (n = 100). Lasso regression analysis was performed on the risk factors screened by univariate analysis to screen out the final risk factors affecting postpartum hemorrhage. Based on the final risk factors, a Nomogram prediction model with excellent performance was constructed using Logistic regression. A nomogram was constructed with further screening of the selected risk factors of postpartum hemorrhage in PPP. A second nomogram based only on the total ultrasonic risk score was constructed. Decision curve analysis (DCA) was used to evaluate the clinical efficacy of the nomograms. Results: Older age, larger gestational age, larger neonatal birth weight, presence of gestational diabetes mellitus, larger amniotic fluid index, absence of gestational bleeding, and higher ultrasonic risk single score were selected to establish a nomogram for postpartum hemorrhage in PPP. The area under the curve of the nomogram constructed by Lasso regression analysis was higher than that of the ultrasonic total score alone (0.887 vs. 0.833). Additionally, DCA indicated better clinical efficacy in the former nomogram than in the later nomogram. Furthermore, internal verification of the nomogram constructed by Lasso regression analysis showed good agreement between predicted and actual values. Conclusion: A nomogram for postpartum hemorrhage in PPP was developed and validated to assist clinicians in evaluating postpartum hemorrhage. This nomogram was more accurate than using the ultrasonic score alone.
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Affiliation(s)
- Yangzi Zhou
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zixuan Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoxue Wang
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mingjie Zhang
- Department of Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueting Chen
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dandan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Dandan Zhang,
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16
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Dang X, Zhang L, Bao Y, Xu J, Du H, Wang S, Liu Y, Deng D, Chen S, Zeng W, Feng L, Liu H. Developing and Validating Nomogram to Predict Severe Postpartum Hemorrhage in Women With Placenta Previa Undergoing Cesarean Delivery: A Multicenter Retrospective Case-Control Study. Front Med (Lausanne) 2022; 8:789529. [PMID: 35223881 PMCID: PMC8873861 DOI: 10.3389/fmed.2021.789529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/24/2021] [Indexed: 12/26/2022] Open
Abstract
Objective Developing and validating nomogram to predict severe postpartum hemorrhage (SPPH) in women with placenta previa (PP) undergoing cesarean delivery. Methods We conducted a multicenter retrospective case-control study in five hospitals. In this study, 865 patients from January, 2018 to June, 2020 were enrolled in the development cohort, and 307 patients from July, 2020 to June, 2021 were enrolled in the validation cohort. Independent risk factors for SPPH were obtained by using the multivariate logistic regression, and preoperative nomogram and intraoperative nomogram were developed, respectively. We compared the discrimination, calibration, and net benefit of the two nomograms in the development cohort and validation cohort. Then, we tested whether the intraoperative nomogram could be used before operation. Results There were 204 patients (23.58%) in development cohort and 80 patients (26.06%) in validation cohort experienced SPPH. In development cohort, the areas under the receiver operating characteristic (ROC) curve (AUC) of the preoperative nomogram and intraoperative nomogram were 0.831 (95% CI, 0.804, 0.855) and 0.880 (95% CI, 0.854, 0.905), respectively. In validation cohort, the AUC of the preoperative nomogram and intraoperative nomogram were 0.825 (95% CI, 0.772, 0.877) and 0.853 (95% CI, 0.808, 0.898), respectively. In the validation cohort, the AUC was 0.839 (95% CI, 0.789, 0.888) when the intraoperative nomogram was used before operation. Conclusion We developed the preoperative nomogram and intraoperative nomogram to predict the risk of SPPH in women with PP undergoing cesarean delivery. By comparing the discrimination, calibration, and net benefit of the two nomograms in the development cohort and validation cohort, we think that the intraoperative nomogram performed better. Moreover, application of the intraoperative nomogram before operation can still achieve good prediction effect, which can be improved if the severity of placenta accreta spectrum (PAS) can be accurately distinguished preoperatively. We expect to conduct further prospective external validation studies on the intraoperative nomogram to evaluate its application value.
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Affiliation(s)
- Xiaohe Dang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Wuhan, China
| | - Yindi Bao
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jie Xu
- Department of Obstetrics, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, China
| | - Hui Du
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanyan Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongrui Deng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suhua Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanjiang Zeng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haiyi Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Haiyi Liu
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17
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Wang Y, Zhou Y, Zeng L, Chen L, Zhao Y. Analysis of risk factors for massive intraoperative bleeding in patients with placenta accreta spectrum. BMC Pregnancy Childbirth 2022; 22:116. [PMID: 35148709 PMCID: PMC8832829 DOI: 10.1186/s12884-022-04391-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/11/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To analyze relevant factors for massive postpartum hemorrhage in women with placenta accreta spectrum in order to improve the ability to identify those at risk for intraoperative bleeding and improve outcome. METHODS This study is a retrospective study and based on data from Hospital electronic medical record. Placenta accreta patients who delivered by cesarean section at Peking University Third Hospital from September 2017 to December 2019 were selected and included. According to the amount of intraoperative bleeding, they were categoried into the massive bleeding group (bleeding volume ≥ 2000 mL, 68 cases) and non-massive bleeding group (bleeding volume < 2000 mL, 99 cases). Univariate analysis and multivariate logistic regression were used to analyze the correlations between related risk factors or ultrasound imaging characteristics and the severity of bleeding during operation. RESULTS (1) There were statistically significant differences in gravidity, parity, number of prior cesarean deliveries and placenta accreta ultrasound scores (P < 0.05) between the two groups of patients. (2) Among the ultrasonographic indicators, the disappearance of the post-placental clear space, the emergence of cross-border blood vessels in the region of subplacental vascularity, interruption or disappearance of the bladder line, and the presence of the cervical blood sinus had the most significant correlation with hemorrhage during PAS (P < 0.05). CONCLUSION The presence of cervical blood sinus, interruption or disappearance of bladder line, the disappearance of the post-placental clear space and abnormal subplacental vascularity are independent risk factors for massive hemorrhage during PAS. We should pay more attention to these indicators in prenatal ultrasound examination in order to reduce the intraoperative bleeding and improve maternal outcomes.
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Affiliation(s)
- Yuanyuan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Yadan Zhou
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital, Zhengzhou, 450007, Henan, China
| | - Lin Zeng
- Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China
| | - Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
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Pekar-Zlotin M, Maymon R, Eliassi Revivo P, Ezratty J, Melcer Y, Kugler N, Jauniaux E. Comparison between a prenatal sonographic scoring system and a clinical grading at delivery for Placenta Accreta Spectrum disorders. J Matern Fetal Neonatal Med 2021; 35:8810-8816. [PMID: 34818979 DOI: 10.1080/14767058.2021.2005563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Placenta Accreta Spectrum (PAS) disorders have become a major iatrogenic obstetric complication worldwide. Data on the accuracy of ultrasound examination diagnosis are limited by incomplete confirmation and variability in the description of the different grades of PAS at delivery. The aim of this study was to compare our prenatal routine sonographic screening and diagnostic scoring system with a standardized clinical grading system at birth in patient at risk of PAS. STUDY DESIGN This is a retrospective cohort study of 607 pregnant patients with at least one prior cesarean delivery between December 2013 and December 2018. All patients were assessed for PAS using our institutional prenatal sonographic scoring system and the corresponding ultrasound findings were compared with those of a standardized clinical intra-operative macroscopic grading system of the degree of accreta placentation at vaginal birth or laparotomy. RESULTS PAS was diagnosed clinically at birth in 50 (8.2%) cases, 17 of which were confirmed by histopathology. A low (score ≤ 5), medium (score 6-7), high (score ≥ 8) probability for PAS was reported in 502, 61 and 44 cases, respectively. The probability score increased significantly (p < .001) in women ≥2 prior cesarean deliveries, with an anterior low-lying/placenta previa, with absent clear space, increased in retroplacental vascularity and with the size and numbers of lacunae. The number of cases classified clinically as grade 1 (non-PAS) and 3 (adherent PAS) was significantly (p < .001) lower in women with a high probability score whereas the rates of the other grades was significantly (p < .001) higher. The widest discrepancy between ultrasound probability score and clinical grade was found for grade 2 which, describes a partial placental adherence and grades 4 and 5 which, refer to placental percreta which describes tissue having invade trough the uterine serosa and beyond. CONCLUSIONS Both ends of the spectrum of accreta placentation remain difficult to diagnose antenatal and clinically at birth, in particular when no histopathologic confirmation is available. There is a need to develop ultrasound accuracy score systems that can differentiate between the different grades of PAS and which are validated by standardized clinical and pathology protocols.
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Affiliation(s)
- Marina Pekar-Zlotin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Perry Eliassi Revivo
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jody Ezratty
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Kugler
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
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Khander A, Sharma N, Eroglu I, Chasen ST. Ultrasound detection rates of the placenta accreta spectrum with prior myomectomy. J Matern Fetal Neonatal Med 2021; 35:8752-8755. [PMID: 34763606 DOI: 10.1080/14767058.2021.2001800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the performance of ultrasound in detecting placenta accreta spectrum (PAS) in patients with history of prior myomectomy. METHODS A retrospective cohort study of patients who were referred for sonographic evaluation of the placenta and delivered at a tertiary academic center from 2012 to 2019. Demographic, obstetric, sonographic findings, and pathology information were collected and analyzed using Chi-square, t-tests, and ANOVA analysis. RESULTS 640 patients met inclusion criteria, including 46 (7.2%) with histologically confirmed PAS. Groups for comparison included those with C-section only (CS), CS-Myomectomy, and Myomectomy-only. Those with CS-Myomectomy were older (38.7 years vs. 35.7 years or 35.5 years, p = .003) and those with CS only were more likely to have an anterior placenta (63.4% vs. 54.5% or 41.8%, p = .005). The rate of PAS was highest in those with Myomectomy only (14.5% vs. 6.1% or 11.4%, p = 0.04). Sensitivity, Specificity, and Predictive Values were lowest in the CS-Myomectomy group, with detection rate and PPV of only 40%. Accuracy, defined as the rate of clinical outcome consistent with imaging, was significantly higher in those with CS only compared to the CS with myomectomy or myomectomy-only groups. Of the histologically confirmed PAS, 11 (23.9%) did not have a placenta previa, and the majority of these occurred in women with prior myomectomy. In the cohort with CS only, the proportion of cases with PAS without placenta previa was 5 of 33 (15.2%) compared to 6 of 13 (46.2%) of PAS in those with prior myomectomy, with or without CS (p = .05). CONCLUSION In patients with prior uterine surgery referred for sonographic evaluation of the placenta, rates of histology-confirmed PAS were highest in those with prior myomectomy, though ultrasound accuracy was lower in these patients. As ultrasound findings of PAS may be clearer in the presence of placenta previa, the absence of previa in a higher proportion of PAS with prior myomectomy may be related to the observed lower sonographic accuracy in these patients.
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Affiliation(s)
- Amrin Khander
- Division of Maternal-Fetal Medicine, Department of OB-GYN, Weill Cornell School of Medicine, New York, NY, USA
| | | | - Idil Eroglu
- Weill Cornell School of Medicine, New York, NY, USA
| | - Stephen T Chasen
- Division of Maternal-Fetal Medicine, Department of OB-GYN, Weill Cornell School of Medicine, New York, NY, USA
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Li P, Tang Y, Jiang Y, Li D. Analysis of clinical features of 231 cases with pernicious placenta previa: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e25023. [PMID: 33725977 PMCID: PMC7982193 DOI: 10.1097/md.0000000000025023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/10/2021] [Indexed: 01/05/2023] Open
Abstract
Pernicious placenta previa (PEPP) is a severe complication of late pregnancy, which might result in adverse maternal-fetal outcome. To explore the application value of placenta accreta score (PAS) for PEPP and its association with maternal-fetal outcome.In this retrospective cohort study, the clinical data of PEPP patients were analyzed. According to the ultrasonic PAS, patients were grouped into 3 groups: scores ≤5, a scores between 6 and 9, and scores ≥10. The clinical data, intraoperative and postoperative outcomes were collected. Receiver operating characteristic (ROC) curves were used to evaluate the performance of PAS in disease severity evaluation. Multivariate logistic and linear regression analysis were performed to assess associations of PAS with intraoperative and postoperative outcomes.A total of 231 patients were enrolled. There were significant differences in intraoperative, postoperative and neonatal outcomes, such as operation time, bladder repair, ICU admission, postoperative hospitalization days, operation complications, Apgar score of newborns in 1 minute and premature delivery among the 3 groups (all P < .05), while the worst outcomes were found in those with a score ≥ 10 (all P < .05). According to ROC curves, scores <5.5, between 5.5 and 7.5, and >7.5 indicated placenta accreta, placenta increta and placenta percreta, respectively. PAS was independently associated with longer time of operation, surgical complications, intraoperative bleeding volume, and postoperative hospitalization days (all P < .05).Placenta accreta score might help with PEPP subtype diagnosis and predict the maternal-fetal outcome of PEPP patients.
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Del Negro V, Aleksa N, Galli C, Ciminello E, Derme M, Vena F, Muzii L, Piccioni MG. Ultrasonographic Diagnosis of Placenta Accreta Spectrum (PAS) Disorder: Ideation of an Ultrasonographic Score and Correlation with Surgical and Neonatal Outcomes. Diagnostics (Basel) 2020; 11:diagnostics11010023. [PMID: 33375532 PMCID: PMC7824485 DOI: 10.3390/diagnostics11010023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Valentina Del Negro
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.N.); (N.A.); (C.G.); (M.D.); (F.V.); (L.M.)
| | - Natalia Aleksa
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.N.); (N.A.); (C.G.); (M.D.); (F.V.); (L.M.)
| | - Cecilia Galli
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.N.); (N.A.); (C.G.); (M.D.); (F.V.); (L.M.)
| | - Enrico Ciminello
- Department of Statistical Sciences, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Martina Derme
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.N.); (N.A.); (C.G.); (M.D.); (F.V.); (L.M.)
| | - Flaminia Vena
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.N.); (N.A.); (C.G.); (M.D.); (F.V.); (L.M.)
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.N.); (N.A.); (C.G.); (M.D.); (F.V.); (L.M.)
| | - Maria Grazia Piccioni
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.N.); (N.A.); (C.G.); (M.D.); (F.V.); (L.M.)
- Correspondence:
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Hussein AM, Momtaz M, Elsheikhah A, Abdelbar A, Kamel A. The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders. Arch Gynecol Obstet 2020; 302:1143-1150. [PMID: 32740869 DOI: 10.1007/s00404-020-05707-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/25/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the value of various grey-scale ultrasound, 2D color Doppler, and 3D power Doppler sonographic markers in predicting major intraoperative blood loss during planned cesarean hysterectomy for cases diagnosed with placenta accreta spectrum (PAS) disorders. METHODS 50 women diagnosed with PAS were scanned the day before planned delivery and hysterectomy for various sonographic markers indicative of placental invasion. These women were then later divided according to blood loss in two groups: group A (minor hemorrhage, < 2500 ml), and group B (major hemorrhage, > 2500 ml), and the data were analyzed. RESULTS The odds ratio (OR) for major hemorrhage was as follows for the following sonographic markers: 'number of lacunae > 4' OR 3.8 95% CI (1.0-13.8) (p = 0.047); 'subplacental hypervascularity' OR 10.8 95% CI (1.2-98.0) (p = 0.035); 'tortuous vascularity with 'chaotic branching' OR 10.8 95%CI (1.2-98.0) (p = 0.035); 'numerous coherent vessels involving the serosa-bladder interface OR 14.6 95% CI (2.7-80.5) (p = 0.002); and 'presence of bridging vessels OR 2.9 95% CI (1.4-6.9) (p = 0.005). Only the presence of numerous coherent vessels involving the bladder-serosal interface (p = 0.002) was proven to be independent predictor of major hemorrhage during hysterectomy. CONCLUSION The use of 2D color Doppler and 3D power Doppler can help predict massive hemorrhage in cases of PAS disorders.
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Affiliation(s)
- Ahmed M Hussein
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohamed Momtaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ahmad Elsheikhah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ahmed Abdelbar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ahmed Kamel
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt.
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Xia H, Ke SC, Qian RR, Lin JG, Li Y, Zhang X. Comparison between abdominal ultrasound and nuclear magnetic resonance imaging detection of placenta accreta in the second and third trimester of pregnancy. Medicine (Baltimore) 2020; 99:e17908. [PMID: 31914010 PMCID: PMC6959867 DOI: 10.1097/md.0000000000017908] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This study is to determine accuracy of abdominal ultrasound and nuclear magnetic resonance imaging (MRI) for placenta accreta in the second and third trimester of pregnancy and to define the most relevant features of abdominal ultrasound and MRI for placenta accreta prediction.Between September 2012 and September 2018, 245 high risk of placenta accreta in the second trimester of pregnancy were prenatal diagnosed by abdominal ultrasound and MRI and they were followed up until the end of pregnancy.Forty-six patients at the second trimester of pregnancy and 40 patients at the third trimester of pregnancy were confirmed as placenta accreta. For the second and third trimester of pregnancy, the sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV) of abdominal ultrasound were 95.65% versus 97.50%, 91.78% versus 90.70%, 88% versus 83%, and 97% versus 99%, respectively, while the Se, Sp, PPV, and NPV of MRI were 89.13% versus 92.50%, 87.67% versus 8721%, 82% versus 77%, and 93% versus 96%, respectively. Five features having significant statistical differences between normal placentation women and placenta accreta patients in second or third trimester of pregnancy, including loss of the normal retroplacental clear space, thinning or disappearance of the myometrium, increased vascularization at the uterine serosa-bladder wall interface, and vascularization perpendicular to the uterine wall on abdominal ultrasound, and uterine bulging and dark intraplacental bands on MRI.Abdominal ultrasound and MRI for placenta accreta in the second and third trimester of pregnancy could provide meaningful imaging evidences.
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Affiliation(s)
- Hui Xia
- Department of Ultrasonography
| | | | | | | | - Yang Li
- Department of Imaging, RuiAn People's Hospital (The Third Affiliated Hospital of Wenzhou Medical University), City of Ruian, Province of Zhejiang, China
| | - Xia Zhang
- Department of Imaging, RuiAn People's Hospital (The Third Affiliated Hospital of Wenzhou Medical University), City of Ruian, Province of Zhejiang, China
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Karaçor T, Bülbül M, Nacar MC, Kirici P, Peker N, Sak S, Sak ME. The parameters affecting the success of uterus-sparing surgery in cases of placenta adhesion spectrum disorder. J Matern Fetal Neonatal Med 2019; 34:1091-1098. [PMID: 31177877 DOI: 10.1080/14767058.2019.1624719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the parameters affecting the treatment success of conservative surgery in cases with placental invasion anomaly. METHODS Archive files and digital image records of 67 patients with placental invasion anomaly were studied. The patients were divided into two groups, a conservative surgery group and a cesarean hysterectomy group. Demographic data, cervical length, placental localization, placental surface area adhering to previous cesarean section line, preoperative and postoperative hematocrit values, transfused blood products, and surgical complications were compared between the two groups. RESULTS In the conservative surgery group, the cervical length was longer (p < .001) and the surface area of the placenta in the previous cesarean scar line was smaller (p < .001). For cervical length, the sensitivity and specificity values were 97 and 81%, respectively, when the cut-off value was 35.5 mm. When the cut-off value for the placental surface area in the previous cesarean scar line was 85.5 cm2, the sensitivity and specificity values were 68 and 72%, respectively. In the caesarean hysterectomy group, the preoperative and postoperative hematocrit values were lower (p < .001, p = .003, respectively), and the amount of transfused erythrocyte suspension and fresh frozen plasma were higher (p < .001, p = .001, respectively). CONCLUSION In this study, it was concluded that the presence of the nondestructive intact cervical tissue, in the cases with placental invasion anomaly and/or the small size of the placental surface area adhering to the previous cesarean scar line, increase the feasibility of conservative surgery.
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Affiliation(s)
- Talip Karaçor
- Department of Obstetrics and Gynecology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Mehmet Bülbül
- Department of Obstetrics and Gynecology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Mehmet Can Nacar
- Department of Obstetrics and Gynecology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Pınar Kirici
- Department of Obstetrics and Gynecology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Nurullah Peker
- Department of Obstetrics and Gynecology, Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Sibel Sak
- Department of Obstetrics and Gynecology, Harran University School of Medicine, Şanlıurfa, Turkey
| | - Muhammet Erdal Sak
- Department of Obstetrics and Gynecology, Harran University School of Medicine, Şanlıurfa, Turkey
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