Outcomes of prospectively-collected consecutive cases of antenatal-suspected placenta accreta

Abstract Background Accurate diagnosis of placenta accreta is tentative before surgery. This study developed a predictive score for antenatal diagnosis of placenta accreta through mathematical modeling using clinical signs. Methods Antenatal cases of suspected placenta accreta were collected prospec...

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Bibliographic Details
Published in:International journal of obstetric anesthesia 2013-11, Vol.22 (4), p.273-279
Main Authors: Weiniger, C.F, Einav, S, Deutsch, L, Ginosar, Y, Ezra, Y, Eid, L
Format: Article
Language:English
Subjects:
Adult
Anesthesia
Anesthesia & Perioperative Care
Female
Hemorrhage
Humans
Logistic Models
Modeling
Models, Theoretical
Obstetrics and Gynecology
Placenta accreta
Placenta Accreta - diagnosis
Pregnancy
Prospective Studies
Risk
ROC Curve
Sensitivity and Specificity
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Summary:Abstract Background Accurate diagnosis of placenta accreta is tentative before surgery. This study developed a predictive score for antenatal diagnosis of placenta accreta through mathematical modeling using clinical signs. Methods Antenatal cases of suspected placenta accreta were collected prospectively in a single-site tertiary delivery center. Women with clinical signs of placenta accreta (placenta previa, number of previous cesarean deliveries and/or ultrasound suspicion of placenta accreta) were included. The diagnosis of accreta was confirmed surgically. The primary endpoint was the proportion of surgically-diagnosed placenta accreta among all suspected cases. Logistic regression modeling was performed to assess preoperative risk factors for placenta accreta. The risk score was tested on a receiver operator characteristic curve to identify subjects with placenta accreta and the optimum cut-point was chosen. Results Over nine years, 92 suspected accreta cases were identified from 46 623 deliveries (0.2%). The diagnosis was confirmed at surgery in 52/92 cases (56%) and there were no maternal deaths. Blood transfusion requirements were greater in patients with placenta accreta versus patients without placenta accreta (median 7 [range 0–25, interquartile range 3–10] versus 0 [0–6, 0–2] units of blood, P
ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2013.04.014