Diagnostic value of early echography in pregnant women at risk for placenta accreta


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Abstract

Objective: To study the diagnostic value of ultrasound assessment at 5-10 weeks gestation in women with risk factors for placenta accreta spectrum (PAS). Materials and methods: This was a retrospective analysis of the data of 181 women. Inclusion criterion was the presence of uterine scar. The ultrasound assessment was performed at 5-10 weeks gestation, the women gave birth at Regional Clinical Hospital No. 2, Krasnodar, Russia from 2017 to 2019. We studied the relationship between PAS and potential predictors, including ultrasound signs (low position of the gestational sac in the uterine cavity; implantation of the gestational sac in the scar; hypervascular pattern at the implantation site; bulge of the uterine wall at the implantation site; subchorionic hematoma) and maternal clinical and demographic parameters (age, parity, number of cesarean sections and other surgeries of the uterus). Results: Diagnostic significance for the prediction of PAS in pregnant women was revealed for cesarean section in history (0R=2.30; 95% CI: 1.50-3.53, p<0.001), low position of gestational sac (0R=17.70; 95% CI: 5.8753.40, p<0.001); increase in the number of ultrasound signs (+1) (0R=7.37; 95% CI: 3.74-14.53, р<0.001). The absence of ultrasound signs had 0R=0.102; 95% CI: 0.049-0.21, p<0.001. Parity and hematoma in the uterine cavity had significant differences only for invasive forms of PAS (increta, percreta). According to ultrasound data at 5-10 weeks gestation, a low position of the gestational sac in combination with the presence of a hematoma in the uterine cavity is suggestive of PAS in pregnant patients with >1 scar after cesarean section with Se=61.11 (95% CI: 48.89-72.38); Sp=88.07(95% CI: 80.47-93.49);LR(+)=5.12(95% CI: 2.98-8.81); LR(-)=0.44(95% CI: 0.33-0.59); PPV=98.98(95% CI: 98.26-99.41); NPV=10.65(95% CI: 8.13-13.83). Conclusion: Ultrasound assessment at an early stage of pregnancy can be used for selective screening of PAS.

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About the authors

Tatiana B. Makukhina

Regional Clinical Hospital No. 2, Ministry of Health of the Krasnodar Territory; Kuban State Medical University, Ministry of Health of Russia

Email: soltamna@mam.ru
PhD, Associate Professor, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology, Faculty of Advanced Training and Professional Retraining of Specialists

Grigoriy A. Penzhoyan

Regional Clinical Hospital No. 2, Ministry of Health of the Krasnodar Territory; Kuban State Medical University, Ministry of Health of Russia

Email: pga05@mail.ru
Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Perinatology, Faculty of Advanced Training and Professional Retraining of Specialists

Maria V. Dontsova

Kuban State University, Ministry of Science and Higher Education of the Russian Federation

PhD (sociological sciences), Associate Professor, Associate Professor at the Department of Sociology

Natalia V. Krivonosova

Kuban State Medical University, Ministry of Health of Russia

PhD, Associate Professor, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology Faculty of Advanced Training and Professional Retraining of Specialists

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