Sensitivity Level of Placenta Accreta Index (PAI) Score and Placenta Accreta Spectrum (PAS) Stage as Preoperative Diagnostic Tools for Placenta Accreta Spectrum Disorders (PASD) at Haji Adam Malik General Hospital Medan Indonesia

2021 ◽  
Vol 17 ◽  
Author(s):  
Utari Purnama ◽  
Makmur Sitepu ◽  
Deri Edianto ◽  
Sarma Nursani Lumbanraja ◽  
Yudha Sudewo ◽  
...  
Keyword(s):  
General Hospital ◽  
Ultrasound Examination ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Diagnostic Value ◽  
Diagnostic Tools ◽  
Predictive Values ◽  
Diagnostic Values ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Background: The incidence of Placenta Accreta Spectrum Disorders (PASD) increases by 10-fold in 50 years along with the number of cesarean sections. Ultrasound examination using Placenta Accreta Index (PAI) score and Placenta Accreta Spectrum (PAS) stage as a predictor of PASD has been used worldwide at the antenatal screening. The high diagnostic value of these tools will help the physician to diagnose PASD early and minimize the rate of maternal neonatal mortality and morbidity. Objectives: To evaluate the value of PAI score and PAS stage in diagnosing PASD. Methods: This study is a diagnostic test study using the medical records of mothers who gave birth at Haji Adam Malik General Hospital Medan Indonesia between September 2017 to September 2020, who were diagnosed preoperatively as placenta previa suspected PASD through ultrasound examination using PAI score or PAS stage. The results of these two diagnostic tests were compared to clinical diagnostic criteria of PASD from The International Federation of Obstetrics and Gynecology (FIGO) with or without histopathological confirmation. Results: Of the 177 placenta previa cases, there were 142 women with PASD (80.2%). The diagnostic values of PAI score with 4.6 as an optimal cut-off point were 75% sensitivity, 83% specificity, 94% positive predictive values (PPV), and 47% negative predictive values (NPV). The diagnostic values of the PAS stage were 90% sensitivity, 83%, specificity, 96% PPV, and 68% NPV. Conclusion: PAI score and PAS stage have a diagnostic value that looks equally good when used as a diagnostic tool for PASD.

scholarly journals Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal

2021 ◽  
Vol 34 (4) ◽  
pp. 266
Author(s):  
Margarida Cal ◽  
Carla Nunes ◽  
Nuno Clode ◽  
Diogo Ayres-de-Campos
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Team Approach ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Introduction: Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade.Material and Methods: Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included.Results: During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta.Discussion: Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes.Conclusion: This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

scholarly journals Can introvoxel incoherent motion MRI be used to differentiate patients with placenta accreta spectrum disorders?

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tao Lu ◽  
Hong Pu ◽  
Kui-de Li ◽  
Jie Mei ◽  
Meng-wei Huang ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Multiple Comparisons ◽  
Placental Perfusion ◽  
Perfusion Fraction ◽  
Motion Mri ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
Study Participants ◽  
And Diffusion

Abstract Background The incidence of PAS disorders increased rapidly in recent years, and introvoxel incoherent motion (IVIM) MRI has been applied in the assessment of placenta. The study aims to investigate whether the parameters from IVIM can be used to differentiate patients with PAS disorders complicating placenta previa and secondly to differentiate different categories of PAS disorders. Methods The study participants were comprised of 99 patients with placenta previa, including 16 patients with placenta accreta, 51 patients with increta, 8 patients with percreta and 24 patients without PAS disorders between 28 + 0 and 39 + 6 weeks. IVIM MRI was performed on a 1.5 T scanner. Perfusion fraction (f), pseudodiffusion coefficient (D*) and diffusion coefficient (D) were calculated. Results Women with PAS disorders had a higher perfusion fraction (p = 0.019) than women without the disease. Multiple comparisons showed perfusion fraction in patients without PAS disorders was significantly lower than in patients with placenta accreta and percreta(P = 0.018 and 0.033 respectively), but was not lower than in patients with increta(p = 1). Conclusion Patients with placenta accreta and percreta differed in placental perfusion fraction from women with increta and without PAS disorders.

scholarly journals Can IVIM MRI be used to differentiate patients with placenta accreta spectrum disorders?

2019 ◽  
Author(s):  
Tao Lu ◽  
Hong Pu ◽  
Kuide Li ◽  
Jie Mei ◽  
Meng-wei Huang ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Multiple Comparisons ◽  
Placental Perfusion ◽  
Perfusion Fraction ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
Study Participants

Abstract Objective Background The incidence of PAS disorders increased rapidly in recent years, and introvoxel incoherent motion (IVIM) MRI has been applied in the assessment of placenta. The study aims to investigate whether the parameters from IVIM can be used to differentiate patients with PAS disorders complicating placenta previa and secondly to differentiate different categories of PAS disorders. Methods The study participants were comprised of 99 patients with placenta previa, including 16 patients with placenta accreta, 51 patients with increta, 8 patients with percreta and 24 patients without PAS disorders between 28+0 and 39+6 weeks. IVIM MRI was performed on a 1.5T scanner. Perfusion fraction (f), pseudodiffusion coefficient (D*) and standard diffusion coefficient (D) were calculated. Results Women with PAS disorders had a higher perfusion fraction (p=0.019) than women without the disease. Multiple comparisons showed perfusion fraction in patients without PAS disorders was significantly lower than in patients with placenta accreta and percreta(P=0.018 and 0.033 respectively), but was not lower than in patients with increta(p=1). Conclusion Patients with placenta accreta and percreta differed in placental perfusion fraction from women with increta and without PAS disorders.

scholarly journals Can introvoxel incoherent motion MRI be used to differentiate patients with placenta accreta spectrum disorders?

2019 ◽  
Author(s):  
Tao Lu ◽  
Hong Pu ◽  
Kuide Li ◽  
Jie Mei ◽  
Meng-wei Huang ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Multiple Comparisons ◽  
Placental Perfusion ◽  
Perfusion Fraction ◽  
Motion Mri ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
Study Participants

Abstract The incidence of PAS disorders increased rapidly in recent years, and introvoxel incoherent motion (IVIM) MRI has been applied in the assessment of placenta. The study aims to investigate whether the parameters from IVIM can be used to differentiate patients with PAS disorders complicating placenta previa and secondly to differentiate different categories of PAS disorders. Methods The study participants were comprised of 99 patients with placenta previa, including 16 patients with placenta accreta, 51 patients with increta, 8 patients with percreta and 24 patients without PAS disorders between 28+0 and 39+6 weeks. IVIM MRI was performed on a 1.5T scanner. Perfusion fraction (f), pseudodiffusion coefficient (D*) and standard diffusion coefficient (D) were calculated. Results Women with PAS disorders had a higher perfusion fraction (p=0.019) than women without the disease. Multiple comparisons showed perfusion fraction in patients without PAS disorders was significantly lower than in patients with placenta accreta and percreta(P=0.018 and 0.033 respectively), but was not lower than in patients with increta(p=1). Conclusion Patients with placenta accreta and percreta differed in placental perfusion fraction from women with increta and without PAS disorders.

scholarly journals Can introvoxel incoherent motion MRI be used to differentiate patients with placenta accreta spectrum disorders?

2019 ◽  
Author(s):  
Tao Lu ◽  
Hong Pu ◽  
Kuide Li ◽  
Jie Mei ◽  
Meng-wei Huang ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Multiple Comparisons ◽  
Placental Perfusion ◽  
Perfusion Fraction ◽  
Motion Mri ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
Study Participants

Abstract Objective Background The incidence of PAS disorders increased rapidly in recent years, and introvoxel incoherent motion (IVIM) MRI has been applied in the assessment of placenta. The study aims to investigate whether the parameters from IVIM can be used to differentiate patients with PAS disorders complicating placenta previa and secondly to differentiate different categories of PAS disorders. Methods The study participants were comprised of 99 patients with placenta previa, including 16 patients with placenta accreta, 51 patients with increta, 8 patients with percreta and 24 patients without PAS disorders between 28+0 and 39+6 weeks. IVIM MRI was performed on a 1.5T scanner. Perfusion fraction (f), pseudodiffusion coefficient (D*) and standard diffusion coefficient (D) were calculated. Results Women with PAS disorders had a higher perfusion fraction (p=0.019) than women without the disease. Multiple comparisons showed perfusion fraction in patients without PAS disorders was significantly lower than in patients with placenta accreta and percreta(P=0.018 and 0.033 respectively), but was not lower than in patients with increta(p=1). Conclusion Patients with placenta accreta and percreta differed in placental perfusion fraction from women with increta and without PAS disorders.

scholarly journals Placenta Accreta Spectrum Disorder in a Patient with Six Previous Caesarean Deliveries: Step by Step Management

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Calagna Gloria ◽  
Polito Salvatore ◽  
Labate Francesco ◽  
Guiglia Rosa Anna ◽  
De Maria Francesca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Scientific Community ◽  
Caesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
International Federation ◽  
Difficult Case ◽  
Referral Center ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

The definition placenta accreta spectrum disorders (PAS) introduced by FIGO (International Federation of Gynaecology and Obstetrics) indicates an abnormal, pathological adherence or invasion of the placenta. The growing worldwide incidence of this pathological entity, and the possible serious correlated surgical risks, has caused a significant increase in attention among the scientific community. Previous caesarean delivery and presence of placenta previa are the main risk factors for the onset of PAS. Here, we present the intriguing case of a 39-year-old woman, at the 33rd week of gestation, with six previous caesarean sections and with a diagnosis of placenta previa accreta. At our referral center for PAS disorders, we successfully managed this difficult case with the help of a multidisciplinary skilled team.

scholarly journals Can IVIM MRI be used to differentiate patients with placenta accreta spectrum disorders?

2019 ◽  
Author(s):  
Tao Lu ◽  
Hong Pu ◽  
Kuide Li ◽  
Jie Mei ◽  
Meng-wei Huang ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Multiple Comparisons ◽  
Reliable Index ◽  
Placental Perfusion ◽  
Perfusion Fraction ◽  
Mri Examination ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Abstract Objective The primary aim was to investigate whether the parameters from IVIM can be used to differentiate patients with PAS disorders complicating placenta previa. A second aim was to determine whether these parameters can be used to differentiate different categories of PAS disorders complicating placenta previa. Methods All the patients had placenta previa, including 16 patients with placenta accreta, 51 patients with increta, 8 patients with percreta and 24 patients without PAS disorders between 28+0 and 39+6 weeks. All women underwent MRI examination including an IVIM sequence at 1.5T scanner. The perfusion fraction(f), pseudodiffusion coefficient (D*) and standard diffusion coefficient(D) were calculated. Results Women with PAS disorders had a higher perfusion fraction (P<0.05) than women without the disease. Multiple comparisons showed perfusion fraction in patients without PAS disorders was significantly lower than in patients with placenta accreta and percreta(P<0.05), but was not lower than in patients with increta(p>0.05). Conclusion Patients with placenta accreta and percreta differ in placental perfusion fraction from women with increta and without PAS disorders. The perfusion fraction can be used as a reliable index to evaluate placenta perfusion fraction.

Sign in / Sign up

Export Citation Format

Share Document