<scp>FIGO</scp> classification for the clinical diagnosis of placenta accreta spectrum disorders,

Jauniaux, Eric; Ayres‐de‐Campos, Diogo; Langhoff‐Roos, Jens; Fox, Karin A.; Collins, Sally

doi:10.1002/ijgo.12761

Cited by 425 publications

(403 citation statements)

References 19 publications

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“…Therefore, the diagnosis of PAS for most patients was confirmed according to intra-operative findings. There is a recent International Federation of Gynecology and Obstetrics (FIGO) system of clinical classification based on clinical findings (16). The diagnosis of placenta accreta and percreta in the present study was basically consistent with that of the FIGO system.…”

Section: Discussionsupporting

confidence: 87%

Assessment of the massive hemorrhage in placenta accreta spectrum with magnetic resonance imaging

et al. 2020

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The aim of the present study was to evaluate whether MRI features are able to predict massive hemorrhage of patients with placenta accreta spectrum (PAS). A total of 40 patients with suspected PAS after ultrasound examination were subjected to MRI. Of these, 29 patients were confirmed as having PAS. MRI data were analyzed independently by two radiologists in a blinded manner. Inter-observer agreement was determined. The 29 confirmed patients were divided into two groups (moderate and massive hemorrhage) according to the estimated blood loss (EBL) and blood transfusion, and the MRI features were compared between the two groups. The EBL, as well as blood transfusion, between the patients with and without each MRI feature were compared. The inter-observer agreement between the two radiologists for the 11 MRI features had statistical significance (P<0.05). Intra-placental thick dark bands and markedly heterogeneous placenta were the most important MRI features in predicting massive hemorrhage and blood transfusion (P<0.05). The difference in EBL between the patients with and without focal defect of the uteroplacental interface (UPI) was significant (P<0.05). The differences in blood transfusion between the patients with and without myometrial thinning, disruption of the inner layer of the UPI, increased placental vascularity and increased vascularity at the UPI were significant (P<0.05). These results indicate that MRI features may predict massive hemorrhage of patients with PAS, which may be helpful for pre-operative preparation of PAS patients.

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Section: Discussionsupporting

confidence: 87%

Assessment of the massive hemorrhage in placenta accreta spectrum with magnetic resonance imaging

et al. 2020

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“…SGA and LGA were defined as birth weight ≤ 10 th and ≥ 90 th percentiles, respectively. The presence and severity of a PAS disorder was assessed at delivery by an attending obstetrician with experience of PAS, according to the current FIGO‐recommended clinical grading system and from histopathological results if a hysterectomy or partial myometrial resection was performed. In each unit, all pathological examinations were undertaken by senior pathologists with expertise in perinatal pathology.…”

Section: Methodsmentioning

confidence: 99%

Impact of placenta previa with placenta accreta spectrum disorder on fetal growth

Jauniaux

Dimitrova

Kenyon

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To evaluate fetal growth in pregnancies complicated by placenta previa with or without placenta accreta spectrum (PAS) disorder, compared with in pregnancies with a low‐lying placenta. Methods This was a multicenter retrospective cohort study of singleton pregnancies complicated by placenta previa with or without PAS disorder, for which maternal characteristics, ultrasound‐estimated fetal weight and birth weight were available. Four maternal–fetal medicine units participated in data collection of diagnosis, treatment and outcome. The control group comprised singleton pregnancies with a low‐lying placenta (0.5–2 cm from the internal os). The diagnosis of PAS and depth of invasion were confirmed at delivery using both a predefined clinical grading score and histopathological examination. For comparison of pregnancy characteristics and fetal growth parameters, the study groups were matched for smoking status, ethnic origin, fetal sex and gestational age at delivery. Results The study included 82 women with placenta previa with PAS disorder, subdivided into adherent (n = 35) and invasive (n = 47) PAS subgroups, and 146 women with placenta previa without PAS disorder. There were 64 controls with a low‐lying placenta. There was no significant difference in the incidence of small‐for‐gestational age (SGA) (birth weight ≤ 10th percentile) and large‐for‐gestational age (LGA) (birth weight ≥ 90th percentile) between the study groups. Median gestational age at diagnosis was significantly lower in pregnancies with placenta previa without PAS disorder than in the low‐lying placenta group (P = 0.002). No significant difference was found between pregnancies complicated by placenta previa with PAS disorder and those without for any of the variables. Median estimated fetal weight percentile was significantly lower in the adherent compared with the invasive previa–PAS subgroup (P = 0.047). Actual birth weight percentile at delivery did not differ significantly between the subgroups (P = 0.804). Conclusions No difference was seen in fetal growth in pregnancies complicated by placenta previa with PAS disorder compared with those without and compared with those with a low‐lying placenta. There was also no increased incidence of either SGA or LGA neonates in pregnancies with placenta previa and PAS disorder compared with those with placenta previa with spontaneous separation of the placenta at birth. Adverse neonatal outcome in pregnancies complicated by placenta previa and PAS disorder is linked to premature delivery and not to impaired fetal growth. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…Safe delivery in pregnancies complicated by AIP depends on the timely referral of a pregnant woman to a center specialized in treating placental pathologies, especially in the case of placenta percreta (AIP degree of invasion 3A to 3C according to FIGO classification) [3]. Ultrasound as the gold standard for diagnosing AIP in specialized hands yields a sensitivity and specificity of over 90% [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Maternal Serum VEGF Predicts Abnormally Invasive Placenta Better than NT-proBNP: a Multicenter Case-Control Study

et al. 2020

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The aim of this study was to test if maternal serum vascular endothelial growth factor (VEGF) or N-terminal pro B-type natriuretic peptide (NT-proBNP) predicts abnormally invasive placenta (AIP) better. Secondary objective was to test whether the serum levels of VEGF and NT-proBNP can predict the degree of invasion. In a multicenter case–control study design, gestational age-matched serum samples from pregnant women with AIP (n = 44) and uncomplicated pregnancies (n = 55) who had been enrolled at Charité – Universitätsmedizin Berlin, Germany and Centre Hospitalier Régional de la Citadelle in Liège, Belgium were analyzed. Maternal blood serum VEGF and NT-proBNP levels were immunoassayed from samples taken immediately before delivery (GA median: 35 weeks). Biomarker levels were compared between AIP and control group. The correlation of biomarker levels with the clinical AIP degree was assessed. The predictive biomarker ability was characterized through a multivariate regression model and receiver operating characteristic curves. Women with AIP had significantly lower maternal serum VEGF levels (AIP mean 285 pg/ml, 95% CI 248–322, vs. control: 391 pg/ml, 95% CI 356–426, p < 0.01) and higher NT-proBNP levels (AIP median 329 pg/ml, IQR 287–385, vs. control 295 pg/ml, IQR 273–356, p = 0.03). Maternal serum VEGF levels were able to predict AIP better (AUC = 0.729, 0.622–0.836, p < 0.001; VEGF + number of previous cesarean deliveries: AUC = 0.915, 0.853–0.977, p < 0.001). Maternal serum VEGF levels correlated inversely with the clinical AIP degree (r = − 0.32, p < 0.01). In short, maternal serum VEGF, more than NT-proBNP, can help in predicting AIP and hints at the degree of invasion.

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FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders,

Cited by 425 publications

References 19 publications

Assessment of the massive hemorrhage in placenta accreta spectrum with magnetic resonance imaging

Assessment of the massive hemorrhage in placenta accreta spectrum with magnetic resonance imaging

Impact of placenta previa with placenta accreta spectrum disorder on fetal growth

Maternal Serum VEGF Predicts Abnormally Invasive Placenta Better than NT-proBNP: a Multicenter Case-Control Study

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