Efficacy of Simple Ultrasound Staging System in Prediction of Placenta Accreta Spectrum

Abstract

Introduction: Abnormal placentation leading to obstetric haemorrhage is a major obstetric emergency. Due to an increase in the number of cesarean sections over the past few years, the Incidence of placenta accreta spectrum has considerably grown. We aimed at evaluation of the predictability of simple ultrasound staging system in the women at high risk for placenta accreta spectrum through a prospective observational study. Materials and Methods: The study was a prospective observational cohort. It was conducted in Beni-Suef University Hospitals. It included one hundred and twenty-one pregnant women in 3rd pregnancy trimester and at high risk for placenta accreta spectrum. The examination of all women by transvaginal or transabdominal ultrasound was based on a staging system according to the American Institute of Ultrasound in Medicine “AIUM” developed in 2015. This staging system used simple ultrasound parameters of myometrial placental invasion. Ultrasound staging was done among the participating women. The surgical team documented intraoperative findings and complications in patients’ files postoperatively. The simple descriptive analysis in the form of numbers, percentages & arithmetic means was used for qualitative data. The Student t-Test was used to compare measurements of two independent groups for quantitative parametric data. Results: The placenta was inseparable intraoperatively in 35 women (28.9%). The number of past caesarean sections & gestational age at time of caesarean delivery were associated with intra-operative placental invasion ( p value 0.0001 and 0.01 respectively). Ultrasound staging prediction for placental invasion was 100%. Conclusion: Ultrasound staging of the women at risk of placenta accreta spectrum has a very high predictability and strongly avoids adverse maternal and fetal outcomes through antepartum multidisciplinary delivery planning.