Ultrasonographic Diagnosis of Placenta Accreta Spectrum (PAS) Disorder: Ideation of an Ultrasonographic Score and Correlation with Surgical and Neonatal Outcomes

Abstract

The objective of this study was to evaluate a novel ultrasonographic scoring system for the diagnosis of PAS and the prediction of maternal and neonatal outcomes. In this retrospective study, 138 patients with at least one previous caesarean section (CS) and placenta previa were included. They were divided into four groups ranging from Group 0 (Non PAS) to Group 3 (Placenta Percreta) according to the histological or surgical confirmation. Their ultrasound examinations during pregnancy were reviewed according to the nine different ultrasound signs reported by the European Working Group on Abnormally Invasive Placenta. For each parameter, 0 to 2 points were assigned. The sum of the points reflects the severity of PAS with a maximum score of 20. The scoring system revealed good performances in evaluation metrics, with an overall accuracy of 94%. In addition to this, patients’ characteristics and surgical and neonatal outcomes were analyzed with an evidence of higher incidence of complications in severe forms. Our study suggests that antenatal ultrasonographic diagnosis of PAS is feasible with sufficient level of accuracy. This will be important in identifying high-risk patients and implementing preventive strategy.

Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

“…Previous studies have found that blood loss of more than 2500 mL was significantly associated with the need for blood transfusion, ICU admission, and other complications associated with bleeding such as acute renal failure or even maternal death [11,[13][14][15]. Antenatal detection of PAS disorders plays an important role in reducing hemorrhagic morbidities [16][17][18][19][20]. Two-dimensional (2D) ultrasonography is the recommended tool for the diagnosis of PAS, as it has a proven high detection rate and is available in most centers [7,11,13,19,20].…”

Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging

“…For US images, the diagnosis was made using an ultrasound score developed by our working group [ 21 ], previously described and based on ultrasound descriptors suggested by the European Working Group on Abnormally Invasive Placenta (EW-AIP), stratified by severity score and combined with anamnestic data ( Figure 1 ).…”

Maternal urinary vascular endothelial growth factor (VEGF) versus N.T. pro brain natriuretic peptide (NT-pro BNP) as novel biomarkers for placental accreta spectrum (PAS): A case-control study

“…Placenta accreta spectrum (PAS) disorders, previously defined as abnormally adherent placenta, define a variety of conditions characterized by abnormal adhesion and/or invasion of the placental trophoblast to the uterine myometrium. 1 The pathophysiologic mechanisms of PAS remain incompletely clarified. Still, its clinical sequel are clear: placental invasion and the associated hypervascularity involving the uterus and placenta which put women at a great risk for exposure to caesarean hysterectomy, massive hemorrhage, disseminated intravascular coagulopathy, and in the most catastrophic cases, death.…”