Placenta Accreta Spectrum: The Role of Interventional Radiology in Multidisciplinary Management

Sanders, Troy K.; Stewart, Jessica K.

doi:10.1055/s-0043-1771038

Semin intervent Radiol

2023

DOI: 10.1055/s-0043-1771038

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Placenta Accreta Spectrum: The Role of Interventional Radiology in Multidisciplinary Management

Troy K. Sanders,

Jessica K. Stewart

Abstract: Placenta accreta spectrum is increasing in prevalence and poses significant risks to obstetric patients. This article defines characteristics, diagnosis, management, and outcomes of placenta accreta spectrum, highlighting interventional radiology's role in its management as part of a multidisciplinary approach.

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Cited by 2 publications

References 42 publications

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Association between adenomyosis and placenta accreta and mediation effect of assisted reproductive technology on the association: A nationwide observational study

Wada,

Takahashi,

Ogoyama

et al. 2024

Intl J Gynecology & Obste

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ObjectivesTo investigate the association between adenomyosis and placenta accreta spectrum (PAS) and to evaluate the effect of assisted reproductive technology (ART) in mediating this association.MethodsWe retrieved data for singleton women from the Japanese nationwide perinatal registry between 2013 and 2019, excluding women with a history of adenomyomectomy. To investigate the association between adenomyosis and PAS among women, we used a multivariable logistic regression model with multiple imputation for missing data. We evaluated mediation effect of ART including in vitro fertilization and intracytoplasmic sperm injection on the association between adenomyosis and PAS using causal mediation analysis based on the counterfactual approach.ResultsOf 1 500 173 pregnant women, 1539 (0.10%) had adenomyosis. The number receiving ART was 489/1539 (31.8%) and 117 482/1 498 634 (7.8%) in women with and without adenomyosis, respectively. The proportion of women who developed PAS was 21/1539 (1.4%) in women with adenomyosis and 7530/1 498 634 (0.5%) in women without adenomyosis. Adenomyosis was significantly associated with PAS (odds ratio [OR] 1.95; 95% confidence interval [CI] 1.26–3.00; P = 0.002). Mediation analysis showed that OR of the total effect of adenomyosis on PAS was 1.98 (95% CI 1.13–3.04), OR of natural indirect effect (effect explained by ART) was 1.15 (95% CI 1.01–1.41), and OR of natural direct effect (effect unexplained by ART) was 1.72 (95% CI 0.86–2.82). The proportion mediated (natural indirect effect/total effect) was 26.5%. Adenomyosis was also significantly associated with PAS without previa (OR 1.96; 95% CI 1.23–3.13, P = 0.005).ConclusionAdenomyosis was significantly associated with PAS. ART mediated 26.5% of the association between adenomyosis and PAS.

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Association between adenomyosis and placenta accreta and mediation effect of assisted reproductive technology on the association: A nationwide observational study

Wada,

Takahashi,

Ogoyama

et al. 2024

Intl J Gynecology & Obste

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Plasenta akreta spektrumunu öngörmeye yönelik bir skorlama sistemi: prospektif bir çalışma

ÖZTÜRK AĞAOĞLU,

ÇAĞLAR

2023

Cukurova Medical Journal

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Purpose: The aim of this study was to assess the utility of a scoring system using selected ultrasonographic features to predict placenta accreta spectrum (PAS) and its severity in suspicion of PAS. Materials and Methods: This prospective study was conducted with a total of 27 pregnant women with placenta previa totalis with suspicion of PAS between 24 and 37 weeks gestation between July 2019 and January 2020. PAS score was calculated with the following parameters: loss of clear zone, number, size, and regularity of placental lacunae, turbulent flow in lacunae, uterovesical or subplacental hypervascularity, bridging vessels, and the number of previous cesarean section. Patients were divided into groups due to PAS scores and the severity of PAS. Receiver operating characteristics curves were performed to assess the performance of the PAS scoring system. Results: In a total of 27 patients, 7 (25.9%) patients did not have PAS, 5 (18.5%) patients had accreta, 7 (25.9%) patients had increta, and 8 patients (29.6) had percreta. In groups with PAS scores higher than 8, 86% of patients had placenta percreta. PAS score was 2.8±1.4 in the no PAS group, 3.6±1.9 in the accreta group, 5.1±2.4 in the increta group, 9.8±1.6 in the percreta group and statistically higher in the percreta group. The optimal cut-off values of the PAS score to predict abnormal placental invasion was 4.5 (60% sensitivity, 86% specificity), 7.5 for differentiation percreta from increta (87.5% sensitivity, 75% specificity) Conclusion: A PAS scoring system that combines several ultrasound and clinical characteristics may greatly improve prenatal risk assessment and prediction of PAS.

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Placenta Accreta Spectrum: The Role of Interventional Radiology in Multidisciplinary Management

Cited by 2 publications

References 42 publications

Association between adenomyosis and placenta accreta and mediation effect of assisted reproductive technology on the association: A nationwide observational study

Association between adenomyosis and placenta accreta and mediation effect of assisted reproductive technology on the association: A nationwide observational study

Plasenta akreta spektrumunu öngörmeye yönelik bir skorlama sistemi: prospektif bir çalışma

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