Bansal Sugandha, Suri Jyotsna, Bajaj S K, Ahluwalia Charanjeet, Pandey Divya, Mittal Pratima
Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029 India.
Department of Radio-diagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
J Obstet Gynaecol India. 2022 Aug;72(Suppl 1):55-60. doi: 10.1007/s13224-021-01541-7. Epub 2021 Sep 5.
Antenatal diagnosis of placenta accreta spectrum (PAS) can ensure multidisciplinary management at center of excellence which can reduce maternal and fetal complications. This can be established by a scoring system which provides a standardized criterion for the diagnosis and management. The objective of our study was to assess the placenta accreta index (PAI) and its individual parameters for diagnosis of PAS in high-risk patients.
A prospective study was conducted on 71 pregnant women with placenta previa and previous cesarean section. After informed consent, history was taken and ultrasonography was used to calculate the PAI for each patient. Definitive diagnosis was made clinically during cesarean section or by histopathology for those requiring hysterectomy. The data were evaluated using the latest version of Statistical Package for the Social Sciences software.
All ultrasound parameters of placenta accreta index were statistically significant for predicting PAS ( value < 0.001). ROC curve with AUC of 0.87 95% CI of 0.77-0.94 showed that a score of 4.75 was the best cutoff value to diagnose PAS. Out of the 30 patients found to have placental invasion, 22 had a PAI score of more than 4.75. The score was found to have a sensitivity of 73.3%, specificity 95.1%, positive predictive value 91.7%, negative predictive value 83% and diagnostic accuracy 85.9%.
Women with placenta previa and history of previous CS should undergo screening by PAI, and a cutoff value of ≥ 4.75 should be viewed with high index of suspicion for the presence of PAS.
胎盘植入谱系疾病（PAS）的产前诊断可确保在医疗中心进行多学科管理，从而减少母婴并发症。这可以通过一个评分系统来实现，该系统为诊断和管理提供标准化标准。我们研究的目的是评估胎盘植入指数（PAI）及其各个参数在高危患者中诊断PAS的价值。
对71例前置胎盘且有剖宫产史的孕妇进行了一项前瞻性研究。在获得知情同意后，收集病史并使用超声检查计算每位患者的PAI。剖宫产时进行临床确诊，对于需要子宫切除的患者则通过组织病理学确诊。使用最新版本的社会科学统计软件包对数据进行评估。
胎盘植入指数的所有超声参数在预测PAS方面均具有统计学意义（P值<0.001）。AUC为0.87（95%CI为0.77 - 0.94）的ROC曲线显示，4.75分是诊断PAS的最佳临界值。在30例被发现有胎盘植入的患者中，22例的PAI评分超过4.75分。该评分的敏感性为73.3%，特异性为95.1%，阳性预测值为91.7%，阴性预测值为83%，诊断准确性为85.9%。
有前置胎盘和剖宫产史的女性应接受PAI筛查，PAI≥4.75分应高度怀疑存在PAS。
