Department of Obstetrics and Gynecology, the Second Clinical Medical College of Army Medical University, 183 Xinqiao Main Street, Shapingba District, Chongqing, 400037, People's Republic of China.
Arch Gynecol Obstet. 2019 Sep;300(3):783-791. doi: 10.1007/s00404-019-05217-6. Epub 2019 Jun 27.
The clinical outcomes are significantly different in accreta, increta, and percreta. There is currently no scoring system that can preoperatively distinguish its severity in an at-risk population. The aim of this study is to establish a scoring system for the prediction of the severity of placenta accrete spectrum (PAS) in women with placenta previa.
A prospective observational study was conducted in patients with placenta previa who delivered at a Chinese tertiary care center between June 12, 2016 and June 30, 2018. Optimal scaling regression was performed to determine the parameters which really contribute to the prediction of PAS, and calculate percentage of contribution.
Among 392 cases with placenta previa, 79, 53, and 28 had been surgically and/or histologically confirmed as accreta, increta, or percreta, respectively. Seven parameters were scheduled for the estimated scores for PAS, and five of them were finally entered into the predictive model. Their percentage of contribution was as follows: placental lacunas (19%), vascularity at the uterus-bladder interface (17.5%), myometrial thickness and hypoechoic retroplacental zone (25.6%), bladder line (22.6%), and previous caesarean sections (15.3%). The thresholds of scores for the prediction of accreta, increta, and percreta yielded 2.25-6.2, 6.2-8.95, and ≧ 8.95, respectively, with the positive and negative predictive value, and false positive rates of the scoring system were 96.68%, 95.44%, and 3.32%, respectively.
The scoring system can predict the severity of PAS in women with placenta previa. This will help identify the actual high-risk patients and improve their treatment.
粘连、植入和穿透性胎盘植入的临床结局有显著差异。目前尚无评分系统能够在高危人群中术前区分其严重程度。本研究旨在建立一种评分系统，以预测前置胎盘患者胎盘植入谱（PAS）的严重程度。
对 2016 年 6 月 12 日至 2018 年 6 月 30 日在一家中国三级保健中心分娩的前置胎盘患者进行前瞻性观察性研究。采用最优标度回归确定真正有助于 PAS 预测的参数，并计算其贡献百分比。
在 392 例前置胎盘患者中，79、53 和 28 例分别经手术和/或组织学证实为粘连、植入或穿透性胎盘植入。为 PAS 评分制定了 7 个参数，其中 5 个最终纳入预测模型。它们的贡献百分比如下：胎盘腔隙（19%）、子宫-膀胱界面的血管性（17.5%）、子宫肌层厚度和低回声胎盘后间隙（25.6%）、膀胱线（22.6%）和既往剖宫产术（15.3%）。预测粘连、植入和穿透性 PAS 的评分阈值分别为 2.25-6.2、6.2-8.95 和≧8.95，其评分系统的阳性和阴性预测值以及假阳性率分别为 96.68%、95.44%和 3.32%。
该评分系统可预测前置胎盘患者 PAS 的严重程度。这将有助于识别实际的高危患者并改善他们的治疗。
