Dereli Murat Levent, Sucu Sadun, Sucu Serap Topkara, Özkan Sadullah, Fıratlıgil Fahri Burçin, Yücel Kadriye Yakut, Duran Firdevs Şahin, Üstün Yaprak Engin, Çelen Şevki, Çağlar Ali Turhan
Ankara Etlik Lady Zübeyde Women's Health Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, P.O. Box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey.
Ankara Etlik City Hospital, Department of Obstetrics and Gynecology, P.O. Box 06170, Halil Sezai Erkut Street No:5, Yenimahalle, Ankara, Turkey.
Placenta. 2025 Jan;159:154-160. doi: 10.1016/j.placenta.2024.12.013. Epub 2024 Dec 20.
Prenatal determination of placenta accreta spectrum (PAS) and its severity is crucial, as it is a highly morbid condition. The aim was to investigate the intraplacental fetal artery (IFA) as a novel ultrasonographic marker in predicting cesarean-hysterectomy need in PAS.
A prospective observational cohort study was conducted with a total of 62 women with placenta previa and ≥1 previous cesarean-section who were managed for PAS between September 2022 and January 2024. All women were classified according to the ultrasonographic classification system for prenatal PAS, and ultrasonographic assessments for IFA were performed. Odds ratios were calculated to test the association of IFA and other parameters related to PAS with cesarean-hysterectomy need. Receiver operating characteristic analysis was performed to evaluate the ability of maximum diameter (D-max) of IFA to predict cesarean-hysterectomy need.
The study was completed with 49 women who underwent a cesarean-section with uterus-sparing surgery (n = 22) and a cesarean-hysterectomy (n = 27). Outer placental-half extension of IFA and each 1 mm increase in IFA D-max >3.5 mm were associated with a 58.82- and 3.52-fold increased risk of cesarean-hysterectomy, respectively. An IFA D-max of >3.5 mm was associated with cesarean-hysterectomy need at any PAS stage [area under the curve (AUC) = 0.845, 95 % CI:0.71-0.93, p < 0.001)] and in PAS 2 patients (AUC = 0.750, 95 % CI:0.56-0.89, p = 0.010), in whom prenatal prediction of cesarean-hysterectomy need is difficult.
Evaluation of D-max and outer placental-half extension of IFA along with other markers of PAS improved the ability of ultrasonography to predict cesarean-hysterectomy need.
产前确定胎盘植入谱系（PAS）及其严重程度至关重要，因为这是一种高风险疾病。目的是研究胎盘内胎儿动脉（IFA）作为预测PAS患者剖宫产子宫切除术需求的一种新型超声标志物。
对2022年9月至2024年1月期间共62例前置胎盘且既往有≥1次剖宫产史并接受PAS治疗的女性进行了一项前瞻性观察队列研究。所有女性均根据产前PAS的超声分类系统进行分类，并对IFA进行超声评估。计算比值比以检验IFA和其他与PAS相关参数与剖宫产子宫切除术需求之间的关联。进行受试者操作特征分析以评估IFA最大直径（D-max）预测剖宫产子宫切除术需求的能力。
该研究完成，49例女性接受了保留子宫的剖宫产手术（n = 22）和剖宫产子宫切除术（n = 27）。IFA胎盘外半侧延伸以及IFA D-max > 3.5 mm每增加1 mm分别与剖宫产子宫切除术风险增加58.82倍和3.52倍相关。在任何PAS阶段，IFA D-max > 3.5 mm与剖宫产子宫切除术需求相关[曲线下面积（AUC）= 0.845，95% CI：0.71 - 0.93，p < 0.001]，在PAS 2期患者中也是如此（AUC = 0.750，95% CI：0.56 - 0.89，p = 0.010），在这些患者中产前预测剖宫产子宫切除术需求较为困难。
评估IFA的D-max和胎盘外半侧延伸以及PAS的其他标志物可提高超声预测剖宫产子宫切除术需求的能力。
