Elmaraghy Ahmed Mohammed, Taha Fayed Salah, Abd ElHamid Ali Mahmoud, Ali Hassanien Monira, Mohamed Mamdouh Ahmed
Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Obstetrics & Gynecology, Bani Sweif Hospital, Ministry of Health, Bani Sweif, Egypt.
Int J Womens Health. 2023 Feb 16;15:311-320. doi: 10.2147/IJWH.S399520. eCollection 2023.
The aim of the study was to evaluate the association between placental thickness and placenta accreta spectrum (PAS) in patients with placenta previa.
In this prospective study, 40 patients diagnosed with placenta previa were included. The maximum placental thickness in the lower uterine segment was obtained using a transabdominal scan. For the image to be deemed suitable, a midline sagittal section of the lower uterine segment (with the implanted placenta) and the cervical canal, with the intervening urinary bladder had been required. Intraoperative attendance was ensured for the detection of cases with spontaneous separation and cases with morbid adherence. All specimens removed were sent for histopathology to confirm PAS. The primary outcome of the study was to detect a threshold of placental thickness which can be used as a cut-off value in such screening test. The number of units of packed RBCs transfused during the operation and bladder injury were secondary measures of outcome.
Forty patients were included in the study; 20 patients were ultimately diagnosed with PAS while 20 patients did not have PAS. Mean placental thickness was significantly higher in the PAS patients compared with those with no invasive placentation (61.00 mm Vs 43.00 mm, P value 0.000). Using receiver operating characteristic (ROC) curve, a threshold placental thickness of 58mm was associated with 55% sensitivity, 90% specificity, 84.6% positive predictive value, and 66.7% negative predictive value. Multivariate logistic regression showed that placental thickness more than 58mm and having past history of more than three cesarean sections were independent risk factors for PAS among patients with placenta previa.
Placental thickness in the lower uterine segment is increased in patients with placenta previa with PAS compared to those with no PAS. Such finding can be implemented into clinical practice by using placental thickness as a screening test for PAS in patients with placenta previa.
NCT05500404.
本研究旨在评估前置胎盘患者胎盘厚度与胎盘植入谱系（PAS）之间的关联。
在这项前瞻性研究中，纳入了40例诊断为前置胎盘的患者。通过经腹超声扫描获取子宫下段的最大胎盘厚度。为确保图像合适，需要子宫下段（有植入胎盘）和宫颈管的中线矢状切面，且其间有膀胱。确保术中参与以检测自发分离病例和病态粘连病例。所有切除的标本均送病理检查以确诊PAS。本研究的主要结果是检测出可作为此类筛查试验临界值的胎盘厚度阈值。术中输注的浓缩红细胞单位数和膀胱损伤情况是次要结局指标。
40例患者纳入本研究；20例患者最终诊断为PAS，20例患者无PAS。PAS患者的平均胎盘厚度显著高于无侵袭性胎盘植入的患者（61.00mm对43.00mm，P值0.000）。使用受试者工作特征（ROC）曲线，胎盘厚度阈值为58mm时，敏感性为55%，特异性为90%，阳性预测值为84.6%，阴性预测值为66.7%。多因素逻辑回归显示，胎盘厚度超过58mm且既往剖宫产史超过3次是前置胎盘患者发生PAS的独立危险因素。
与无PAS的前置胎盘患者相比，合并PAS的前置胎盘患者子宫下段的胎盘厚度增加。通过将胎盘厚度作为前置胎盘患者PAS的筛查试验，这一发现可应用于临床实践。
NCT05500404。
