Validation of a scoring system for prediction of obstetric complications in placenta accreta spectrum disorders

Zheng, Weiran; Zhang, Huijing; Ma, Jingmei; Dou, Ruochong; Zhao, Xin; Yan, Jie; Yang, Huixia

doi:10.1080/14767058.2020.1847077

Cited by 17 publications

(16 citation statements)

References 31 publications

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“…In 1993, Chattopadhyay et al (1993) first proposed the concept of pernicious placenta previa (PPP), which refers to placenta previa associated with uterine scar tissue in a woman with a history of cesarean section or myomectomy, and is often accompanied by placenta accreta spectrum disorders (PAS). Clinically, because of a high incidence of PAS, PPP can easily cause fatal and refractory massive bleeding, and even threaten the life of the pregnant woman in serious cases ( Zheng et al, 2021 ). Furthermore, excessive blood transfusion due to bleeding increases the risk of infection and transfusion reaction ( Shafer et al, 1980 ).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-based nomogram for postpartum hemorrhage prediction in pernicious placenta previa

et al. 2022

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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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Section: Introductionmentioning

confidence: 99%

Ultrasound-based nomogram for postpartum hemorrhage prediction in pernicious placenta previa

et al. 2022

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“…As suggested by the published guidelines ( 19 , 20 ), pregnancies with a prior history of cesarean section and/or uterine surgery, low-lying placenta and placenta previa based on ultrasound findings would be screened more rigorously for PAS. The specific ultrasonic signs for PAS were adherent to previously reported guidelines ( 21 , 22 ). MRI was used as an adjunct tool for the ultrasound in the following situations according to the obstetrician’s judgments: suspicions on PAS affecting adjacent pelvic organs, posterior placenta, maternal obesity affecting the diagnostic accuracy of ultrasound or inconclusive assessment on ultrasound.…”

Section: Methodsmentioning

confidence: 80%

Placenta Accreta Spectrum Among Multiple Gestation: A Retrospective Analysis Based on a Chinese Population

et al. 2022

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BackgroundIt remained controversial whether women with multiple gestation are at higher risk of placenta accreta spectrum (PAS) disorders and large-scale studies are needed. This study aimed to assess whether PAS incidence is higher among women with multiple gestation than among singleton, as well as to compare the characteristics and outcomes of PAS in multiple and singleton gestation.MethodsWomen who underwent cesarean section with live births at Peking University First Hospital from January 2015 to December 2020 were included. Demographic and clinical information was collected through chart review. Logistic regression models were used to analyze the associations between multiple gestation and PAS. The clinical characteristics and perioperative outcomes of PAS in multiple and singleton gestation were further compared.ResultsAmong the 14583 women included, 2.4% (352/14583) were diagnosed with PAS. PAS was slightly more prevalent among multiple gestations than among singletons (2.5% vs 2.4%, P=0.857). After adjusting for known risk factors and pregnancy complications, multiple gestation was associated with a higher risk of PAS (aOR=1.63, 95% CI 1.01-2.62). Among PAS patients, women who had multiple births had a significantly lower rate of previous cesarean deliveries (27.6% vs. 56.3%, P=0.003), placenta previa (17.2% vs. 56.3%, P<0.001) and invasive PAS (24.1% vs. 53.9, P=0.002) than singletons. There were no significant differences in perioperative outcomes between these two groups.ConclusionMultiple gestation could be independently associated with an elevated risk of PAS. The clinical characteristics of PAS in the multiple and singleton gestation groups differed significantly in cesarean delivery history and placenta previa. The results of this study may inform guidelines on the screening, early detection and timely intervention of PAS patients among women with multiple births.

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“…Diagnosis of this complication is currently by ultrasonography, with several recent studies reporting satisfactory results produced with this mode of diagnosis. 18 However, in remote areas where there is a lack of ultrasound equipment and experienced operators, the use of biomarkers can be a solution to this challenge. Recently, studies have reported several proangiogenic and antiangiogenic markers associated with the incidence of placenta accreta spectrum.…”

Section: Discussionmentioning

confidence: 99%

Soluble FMS-Like Tyrosine Kinase: Role in placenta accreta spectrum disorder

et al. 2021

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Background: Placenta accreta is a pregnancy condition where the placenta's blood vessels attach too deeply to the uterine wall. Incidence of placenta accreta is increasingly seen today as the rate of cesarean section increases, however, the exact pathophysiology of this condition is still not fully understood. Soluble fms-like tyrosine kinase-1 (sflt-1) as a protein produced by the placenta was found to be decreased in placenta accreta, Therefore we aim to see if sflt-1 has a role in the development of placenta accreta. Methods: This study involved 40 samples from patients that had been diagnosed with placenta accreta spectrum disorder (case group), and 40 samples from patients with normal pregnancies (control group) at Rumah Skit Umum Pusat H.Adam Malik (RSUP) Haji Adam Malik Medan, in Indonesia. Diagnosis of placenta accreta syndrome was based on Placenta Accreta Spectrum Score (PAS), and International Federation of Gynecology and Obstetrics (FIGO) classification of placenta accreta spectrum disorder.Analyses were performed by independent t-test, man Whitney U test, and Kruskal-Wallis analysis test, with a P-value <0.05 considered as statistically significant (95%CI). Results: Based on this study, we found that the sFlt-1 level in the case group was lower than the control group. Data analysis using the Kruskal-Wallis test showed that there was a difference in sFlt-1 levels in this study group (p = 0.02), which was further evaluated with post hoc analysis using Mann. Whitney U test. The results indicated that there were significant differences between the control and PAS 0, PAS1, and PAS 2 (p = 0.043; p = 0.002; p = 0.03). Conclusion: sFlt-1 levels decreased in placental invasive pregnancies compared to normal pregnancies, however, this still needs to be investigated further in a multi-center study, considering that sFlt-1 levels are also influenced by ethnicity and other conditions that cannot be excluded in this study.

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Validation of a scoring system for prediction of obstetric complications in placenta accreta spectrum disorders

Cited by 17 publications

References 31 publications

Ultrasound-based nomogram for postpartum hemorrhage prediction in pernicious placenta previa

Ultrasound-based nomogram for postpartum hemorrhage prediction in pernicious placenta previa

Placenta Accreta Spectrum Among Multiple Gestation: A Retrospective Analysis Based on a Chinese Population

Soluble FMS-Like Tyrosine Kinase: Role in placenta accreta spectrum disorder

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