Background: The incidence of abnormally invasive placenta increases tenfold as the number of caesarian section increases in the past 50 years. Placenta previa accreta is strongly associated with massive bleeding and leads to maternal death. Prenatal diagnosis helps in planning the delivery to reduce the risk of bleeding and possible complications. This study aims to find out diagnostic value of Placenta Accreta Index Score (PAIS) as supporting tool in prenatal diagnostic of abnormally invasive placenta. Methods: The diagnostic test was undertaken in May 2017 at General Hospital of Hasan Sadikin, identifying patients with placenta previa with history of caesarian section between May 2016-May 2017. PAIS were obtained and compared with histopathological findings. Results: Among 21 placenta previa patients with post caesarian section, 10 (47.6%) of them histopathologically proven as abnormally invasive placenta. With statistical analysis accuracy values obtained PAIS and histopathological findings in patient with placenta previa is 0.762 (good). Diagnostic value of PAIS with histopathological findings in placenta previa patient had a sensitivity 70%, a specificity 81,8%, positive predictive value (PPV) 77.8%, and negative predictive value (NPV) 75% by PAIS cut off point is 3.125. No maternal death. Mean duration of postoperative care was 5 days. Average total bleeding during surgery is 2622 ml with lowest postoperative hemoglobin 8.36g/dl. All babies born with appropriate to gestational birth weight with average first minute APGAR was 7 and without fetal anemia. Conclusions: PAIS can be used to help to predict the risk of abnormally.

BACKGROUND: Cholecalciferol, hepcidin, and soluble transferrin receptor (sTfR) interaction play an essential role in iron hemostasis. Anemia in pregnancy contributes to morbidity and mortality both for the mother and baby. In this study, we assessed the correlation between hepcidin, sTfR and cholecalciferol in third trimester maternal anemia. We aimed to find the cut-off for hepcidin and sTfR.METHODS: A case-control study involving 56 pregnant women in each anemia and healthy group was nested on a previous larger cohort study in Indonesia. Serum hepcidin, sTfR and cholecalciferol level were measured by enzyme-linked immunosorbent assay (ELISA) method.RESULTS: Serum hepcidin and sTfR level were significantly higher in case group, while serum cholecalciferol level has no difference between the two groups. New cut-off points were found for hepcidin (<15.93 ng/mL) and sTfR level (>2234.45 ng/mL). Low level of hepcidin (OR=5.32) and high level of sTfR (OR=8.28) increase the risk of anemia. High level of sTfR (adjusted OR=4.725; CI 95%=1.730-12.904; p=0.02) was the most important factor contributes to anemia, followed by the low level of hepcidin (adjusted OR=3.677; CI 95%=1.363-9917; p=0.01).CONCLUSION: The high level of sTfR is the most important factor related to anemia in the third trimester, followed by the low level of hepcidin. Low cholecalciferol level tends to favor the incident of anemia. The new cut-off point of third trimester sTfR and third trimester hepcidin were established in this study and may be useful for risk assessment and treatment monitoring for anemia in pregnancy.KEYWORDS: anemia, cholecalciferol, hepcidin, pregnancy, soluble transferrin receptor