Firmansha Dilmy Mohammad Adya, Purwosunu Yuditiya, Saroyo Yudianto Budi, Hellyanti Tantri, Wibowo Noroyono, Prasmusinto Damar, Irwinda Rima, Andika Santawi Victor Prana, Hasiholan Hizkia Mangaraja, Hiksas Rabbania
Maternal Fetal Division, Department of Obstetrics and Gynaecology, Faculty of Medicine Universitas Indonesia/Cipto-Mangunkusumo Hospital, Java, Indonesia.
Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Cipto-Mangunkusumo Hospital, Java, Indonesia.
Obstet Gynecol Int. 2022 Jun 24;2022:2830066. doi: 10.1155/2022/2830066. eCollection 2022.
Placenta accreta spectrum is an obstetrical complication with a high level of morbidity. The 3-dimensional (3D) power Doppler method has been widely used to improve the diagnosis. Therefore, this study aims to elucidate better the relationship of quantitative placental vascular indices towards macroscopic findings, histopathological grading, and intraoperative blood loss in the disorder.
A preliminary study using a cross-sectional design was conducted on 34 clinically diagnosed women with PAS. The 3D power Doppler with the VOCAL II software was used to measure the level of vascularization index (VI), flow index (FI), and vascularization flow index (VFI). Gross anatomical appearance and histopathology results were categorized as accreta, increta, and percreta. In addition, the intraoperative blood loss level was measured, and 1500 mL was the cutoff for massive hemorrhage.
The vascularity indexes were VI = 44.2 (23.7-74.9), FI = 35.4 (24.9-57), and VFI = 15.3 (8.5-41.7). The FI value was significant in comparing gross pathological stages (=0.015) and had a moderate positive correlation in relation to blood loss ( = 0.449). VI, FI, and VFI above the cutoff values were shown to be strongly associated with blood loss ≥ 1500 cc with aOR 7.00 (95% CI 1.23-39.56), aOR 10.00 (95% CI 1.58-63.09), and aOR 9.16 (95% CI 1.53-54.59), respectively.
This preliminary study demonstrated an initial potential of the FI value from 3D USG power Doppler to predict the depth of PAS invasion before surgery and intraoperative blood loss level.
胎盘植入谱系疾病是一种发病率很高的产科并发症。三维（3D）能量多普勒方法已被广泛用于改善诊断。因此，本研究旨在更好地阐明胎盘定量血管指数与该疾病的宏观表现、组织病理学分级和术中失血之间的关系。
对34例临床诊断为胎盘植入谱系疾病的女性进行了一项采用横断面设计的初步研究。使用带有VOCAL II软件的3D能量多普勒测量血管化指数（VI）、血流指数（FI）和血管化血流指数（VFI）水平。大体解剖外观和组织病理学结果分为粘连性胎盘、植入性胎盘和穿透性胎盘。此外，测量术中失血量，以1500毫升作为大出血的临界值。
血管指数为VI = 44.2（23.7 - 74.9），FI = 35.4（24.9 - 57），VFI = 15.3（8.5 - 41.7）。FI值在比较大体病理分期时具有显著性（P = 0.015），并且与失血量具有中度正相关（P = 0.449）。VI、FI和VFI高于临界值与失血量≥1500 cc密切相关，其比值比分别为7.00（95%可信区间1.23 - 39.56）、10.00（95%可信区间1.58 - 63.09）和9.16（95%可信区间1.53 - 54.59）。
这项初步研究证明了3D超声能量多普勒的FI值在术前预测胎盘植入谱系疾病的浸润深度和术中失血量方面具有初步潜力。
