Comparison between placenta accreta scoring system, ultrasound staging, and clinical classification

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.

Value of early pregnancy ultrasound combined with ultrasound score in the evaluation of placenta accreta in scar uterus: A retrospective cohort study

“…The ultrasonic beam can enter through the back of the bladder and the back of the lateral abdomen to prevent infection by reverberation artifacts and effectively present the lesions. [ 10 ] Zhao et al [ 16 ] showed that the rate of placenta previa, the rate of placenta vortex, the disappearance rate of posterior placental space, the thinning or disappearance rate of posterior placental muscle layer, and the rich rate of posterior placental BF in patients with PA were significantly higher than in those without PA. This shows that ultrasound examination can determine whether PA occurs in patients using relevant imaging features, which is consistent with the findings of this study.…”

“…[7][8][9] Therefore, early accurate diagnosis of PA in scarred uteri is of great significance. Ultrasound is a commonly used diagnostic technique in obstetrics and gynecology, and has the advantages of strong repeatability, simple operation, low cost, and noninvasiveness, and can be used as the preferred examination method for PA. [10] However, examination results are easily affected by doctors' experience, examination time, placental attachment position, PA depth, etc. [10,11] Some studies have used a quantitative ultrasound scoring scale for prenatal diagnosis, which can more accurately distinguish the different degrees of implantation.…”

“…Ultrasound is a commonly used diagnostic technique in obstetrics and gynecology, and has the advantages of strong repeatability, simple operation, low cost, and noninvasiveness, and can be used as the preferred examination method for PA. [ 10 ] However, examination results are easily affected by doctors’ experience, examination time, placental attachment position, PA depth, etc. [ 10 , 11 ] Some studies have used a quantitative ultrasound scoring scale for prenatal diagnosis, which can more accurately distinguish the different degrees of implantation. [ 12 ] The quantitative scoring scale comprehensively considered the influence of placenta previa type, 2-dimensional ultrasound, and color Doppler ultrasound on a variety of typical abnormal signs, as well as focusing on the most difficult ultrasound features of bladder and cervical invasion during surgery; the degree of implantation was evaluated according to the score; compared with simple subjective qualitative diagnosis, it is more comprehensive and standardized, and it excludes different ultrasonic signs selected by different ultrasound physicians according to personal experience, and gives the possibility of implantation judgment of different importance; the rate of missed diagnosis and misdiagnosis was reduced.…”

Prophylactic uterine artery embolization during cesarean delivery for management of hemorrhage in complete placenta previa: An observational study

“…In this study we included only patients with complete placenta previa defined as: placenta previa completely covering cervical OS. All patients with complete placenta previa was evaluated by Ultrasound Scoring System before operation, and ultrasound score ≥ 6 points was identified as suspicious placenta accreta spectrum (PAS) disorder as previous published article, [15][16][17] and patients with suspicious PAS disorder were excluded from the study. All patients in this study were well planned and prepared before operation, elective cesarean section was scheduled between 36 and 38 weeks according to Clinical Practice Guideline.…”