Hanulikova Petra, Savukyne Egle, Fox Karin A, Sobisek Lukas, Mhallem Mina, van Beekhuizen Heleen J, Stefanovic Vedran, Braun Thorsten, Paping Alexander, Bertholdt Charline, Morel Olivier
Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Acta Obstet Gynecol Scand. 2025 Apr;104 Suppl 1(Suppl 1):29-37. doi: 10.1111/aogs.14931. Epub 2024 Sep 11.
The main goal of placenta accreta spectrum (PAS) screening is to enable delivery in an expert center in the presence of an experienced team at an appropriate time. Our study aimed to identify independent risk factors for emergency deliveries within the IS-PAS 2.0 database cohort and establish a multivariate predictive model.
A retrospective analysis of prospectively collected PAS cases from the IS-PAS database between January 2020 and June 2022 by 23 international expert centers was performed. All PAS cases (singleton and multiple pregnancies) managed according to local protocols were included. Individuals with emergent delivery were identified and compared to those with scheduled delivery. A multivariate analysis was conducted to identify the possible risk factors for emergency delivery and was used to establish a predictive model. Maternal outcomes were compared.
Overall, 315 women were included in the study. Of these, 182 participants (89 with emergent and 93 with scheduled delivery) were included in the final analysis after exclusion of those with unsuspected PAS antenatally or who lacked information about the urgency of delivery. Gestational age at delivery was higher in the scheduled group (34.7 vs. 32.9, p < 0.001). Antenatal bleeding (OR 2.9, p = 0.02) and a placenta located over a uterine scar (OR 0.38, p = 0.001) were the independent predictive factors for emergent delivery (AUC 0.68). Ultrasound (US) markers: loss of clear zone (p = 0.001), placental lacunae (p = 0.01), placental bulge (p = 0.02), and presence of bridging vessels (p = 0.02) were more frequently documented in the scheduled group. None of these markers improved the predictive values of the model. Higher PAS grades were identified in the scheduled group (p = 0.01). There were no significant differences in maternal outcomes.
Antenatal bleeding and the placental location away from the uterine scar remained the most significant predictors for emergent delivery among patients with PAS, even when combining more predictive risk factors, including US markers. Based on these results, patients who bleed antenatally may benefit from transfer to an expert center, as we found no differences in maternal outcomes between groups delivered in expert centers. Earlier-scheduled delivery is not supported due to the low predictive value of our model.
胎盘植入谱系（PAS）筛查的主要目标是在有经验的团队在场的情况下，能够在合适的时间在专家中心进行分娩。我们的研究旨在确定IS - PAS 2.0数据库队列中紧急分娩的独立危险因素，并建立一个多变量预测模型。
对2020年1月至2022年6月期间23个国际专家中心从IS - PAS数据库中前瞻性收集的PAS病例进行回顾性分析。纳入所有按照当地方案管理的PAS病例（单胎和多胎妊娠）。确定紧急分娩的个体，并与计划分娩的个体进行比较。进行多变量分析以确定紧急分娩的可能危险因素，并用于建立预测模型。比较孕产妇结局。
总体而言，315名女性纳入研究。其中，排除产前未怀疑PAS或缺乏分娩紧迫性信息的个体后，182名参与者（89名紧急分娩和93名计划分娩）纳入最终分析。计划分娩组的分娩孕周更高（34.7 vs. 32.9，p < 0.001）。产前出血（OR 2.9，p = 0.02）和胎盘位于子宫瘢痕上（OR 0.38，p = 0.001）是紧急分娩的独立预测因素（AUC 0.68）。超声（US）标记物：透明带消失（p = 0.001）、胎盘血池（p = 0.01）、胎盘隆起（p = 0.02）和搭桥血管存在（p = 0.02）在计划分娩组中记录更为频繁。这些标记物均未提高模型的预测价值。计划分娩组的PAS分级更高（p = 0.01）。孕产妇结局无显著差异。
即使结合更多预测危险因素，包括超声标记物，产前出血和胎盘远离子宫瘢痕的位置仍然是PAS患者紧急分娩的最重要预测因素。基于这些结果，产前出血的患者可能受益于转至专家中心，因为我们发现专家中心分娩的组间孕产妇结局无差异。由于我们模型的预测价值较低，不支持提前计划分娩。
