Hasegawa Keita, Ikenoue Satoru, Tanaka Yuya, Oishi Maki, Endo Toyohide, Sato Yu, Ishii Ryota, Kasuga Yoshifumi, Ochiai Daigo, Tanaka Mamoru
Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Sinjuku, Tokyo 1608582, Japan.
Department of Clinical Trial and Clinical Epidemiology, University of Tsukuba Faculty of Medicine, 1-1-1 Tennodai, Tsukuba 305-8577, Japan.
J Clin Med. 2023 Jan 31;12(3):1090. doi: 10.3390/jcm12031090.
This study aimed to investigate the diagnostic accuracy of the placenta accreta index (PAI) for predicting placenta accreta spectrum (PAS) in women with placenta previa. We analyzed 33 pregnancies with placenta previa at Keio University Hospital. The PAI was assessed in the early third trimester, and PAS was diagnosed histologically or clinically defined as retained placenta after manual removal attempts. The PAI and incidence of PAS were analyzed. Ten women (30%) were diagnosed with PAS and had higher volumes of perioperative bleeding ( = 0.016), higher rate of requiring uterine artery embolization ( = 0.005), and peripartum hysterectomy ( = 0.0002) than women without PAS. A PAI > 2 was the most useful cut-off point for predicting PAS and was more sensitive than prediction values using traditional evaluation (history of cesarean section and placental location). Post-hoc analysis revealed a higher rate of previous history of cesarean delivery (30% vs. 4.4%, = 0.038), severe placental lacunae (≥grade2) (70% vs. 8.7%, = 0.0003), thin myometrial thickness (90% vs. 22%, = 0.0003), anterior placenta (100% vs. 30%, = 0.0002), and presence of bridging vessels (30% vs. 0%, = 0.0059) in PAS women. PAI could help predict the outcomes of women with placenta previa with and without a history of cesarean delivery to reduce PAS-induced perinatal complications.
本研究旨在探讨胎盘植入指数（PAI）对前置胎盘孕妇胎盘植入谱系疾病（PAS）的诊断准确性。我们分析了庆应义塾大学医院33例前置胎盘的妊娠病例。在妊娠晚期第三个月早期评估PAI，并通过组织学诊断PAS，或在人工剥离胎盘尝试后临床上将其定义为胎盘残留。分析了PAI和PAS的发生率。10名女性（30%）被诊断为PAS，与未患PAS的女性相比，她们围手术期出血量更多（P = 0.016），需要子宫动脉栓塞的比例更高（P = 0.005），以及行围产期子宫切除术的比例更高（P = 0.0002）。PAI>2是预测PAS最有用的切点，比使用传统评估（剖宫产史和胎盘位置）的预测值更敏感。事后分析显示，PAS女性既往剖宫产史的比例更高（30%对4.4%，P = 0.038）、严重胎盘腔隙（≥2级）的比例更高（70%对8.7%，P = 0.0003）、子宫肌层厚度更薄（90%对22%，P = 0.0003）、前置胎盘的比例更高（100%对30%，P = 0.0002）以及存在搭桥血管的比例更高（30%对0%，P = 0.0059）。PAI有助于预测有无剖宫产史的前置胎盘女性的结局，以减少PAS引起的围产期并发症。
