Maymon R, Melcer Y, Pekar-Zlotin M, Shaked O, Cuckle H, Tovbin J
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center (affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel), 70300, Zerifin, Israel.
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA.
Arch Gynecol Obstet. 2018 Mar;297(3):631-635. doi: 10.1007/s00404-017-4644-x. Epub 2017 Dec 29.
To construct a calculator for 'bedside' estimation of morbidly adherent placenta (MAP) risk based on ultrasound (US) findings.
This retrospective study included all pregnant women with at least one previous cesarean delivery attending in our US unit between December 2013 and January 2017. The examination was based on a scoring system which determines the probability for MAP.
The study population included 471 pregnant women, and 41 of whom (8.7%) were diagnosed with MAP. Based on ROC curve, the most effective US criteria for detection of MAP were the presence of the placental lacunae, obliteration of the utero-placental demarcation, and placenta previa. On the multivariate logistic regression analysis, US findings of placental lacunae (OR = 3.5; 95% CI, 1.2-9.5; P = 0.01), obliteration of the utero-placental demarcation (OR = 12.4; 95% CI, 3.7-41.6; P < 0.0001), and placenta previa (OR = 10.5; 95% CI, 3.5-31.3; P < 0.0001) were associated with MAP. By combining these three parameters, the receiver operating characteristic curve was calculated, yielding an area under the curve of 0.93 (95% CI, 0.87-0.97). Accordingly, we have constructed a simple calculator for 'bedside' estimation of MAP risk. The calculator is mounted on the hospital's internet website ( http://www.assafh.org/Pages/PPCalc/index.html ). The risk estimation of MAP varies between 1.5 and 87%.
The present calculator enables a simple 'bedside' MAP estimation, facilitating accurate and adequate antenatal risk assessment.
构建一种基于超声（US）检查结果对凶险性前置胎盘（MAP）风险进行“床边”评估的计算器。
这项回顾性研究纳入了2013年12月至2017年1月期间在我院超声科就诊的所有有至少一次既往剖宫产史的孕妇。检查基于一种评分系统，该系统可确定MAP的发生概率。
研究人群包括471名孕妇，其中41名（8.7%）被诊断为MAP。基于ROC曲线，检测MAP最有效的超声标准是胎盘血池的存在、子宫胎盘界限消失和前置胎盘。在多因素逻辑回归分析中，胎盘血池的超声表现（OR = 3.5；95% CI，1.2 - 9.5；P = 0.01）、子宫胎盘界限消失（OR = 12.4；95% CI，3.7 - 41.6；P < 0.0001）和前置胎盘（OR = 10.5；95% CI，3.5 - 31.3；P < 0.0001）与MAP相关。通过结合这三个参数，计算出受试者工作特征曲线，曲线下面积为0.93（95% CI，0.87 - 0.97）。因此，我们构建了一个用于“床边”评估MAP风险的简单计算器。该计算器已挂载在医院的互联网网站上（http://www.assafh.org/Pages/PPCalc/index.html）。MAP的风险评估在1.5%至87%之间。
目前的计算器能够进行简单的“床边”MAP评估，有助于准确、充分地进行产前风险评估。
