Correlation of Placenta Accreta Index with Maternal Outcomes in Patients with Morbidly Adherent Placenta

Fatima Sharif Khan; Beenish  Khan; Kaswar Sajjad  Ansari; Munnaza  Andleeb; Surayya  Jabeen; Syeda  Uzma

doi:10.51253/pafmj.v74i6.10291

Authors

Fatima Sharif Khan Department of Gynaecology, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Beenish Khan Department of Gynaecology, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Kaswar Sajjad Ansari Department of Medicine, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Munnaza Andleeb Department of Gynaecology, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Surayya Jabeen Department of Gynaecology, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Syeda Uzma Department of Gynaecology, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i6.10291

Keywords:

Placenta accreta index, Placenta accreta spectrum, Morbidly Adherent Placenta and Ultrasonography

Abstract

Objective: To assess the correlation of a novel scoring system, placenta accreta index with maternal outcomes in placenta accreta spectrum disorders.

Study Design: Prospective longitudinal study

Place and Duration of Study: Obstetrics and Gynecology Department of Combined Military Hospital Quetta, Pakistan from Apr 2022- Mar 2023.

Methodology: A comparative study was carried out at Combined Military Hospital, Quetta after ethical approval. The study spanned over a year from April 2022 to March 2023. Thirty patients in second and third trimester of pregnancy with suspicion of placenta accreta on obstetric ultrasound were included in the study. The placenta accreta index (PAI) was calculated for all patients and morbidly adherent placenta categories were defined. The primary maternal outcome was cesarean hysterectomy.

Results: Cesarean hysterectomy was done in none of the low risk and medium risk patients and it was carried out in 11(84.6%) high risk patients with a p value of <0.001.

Conclusion: Placenta accreta index (PAI) can reliably identify patients at high risk of having morbidly adherent placenta and adverse outcomes. This scoring system can assist obstetricians in timely counseling of patients, effective pre-operative planning and timely intervention to reduce maternal morbidity and mortality.

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References

Panaiotova J, Tokunaka M, Krajewska K, Zosmer N, Nicolaides KH. Screening for morbidly adherent placenta in early pregnancy. Ultrasound Obstet Gynecol 2019 ; 53(1): 101-106.

https://doi.org/10.1002/uog.20104

Morlando M, Collins S. Placenta Accreta Spectrum Disorders: Challenges, Risks, and Management Strategies. Int J Womens Health 2020 10; 12: 1033-1045.

https://doi.org/10.2147/ijwh.s224191

Wang Y, Zhou Y, Zeng L, Chen L, Zhao Y. Analysis of risk factors for massive intraoperative bleeding in patients with placenta accreta spectrum.BMC Pregnancy Childbirth 22,116(2022).

https://doi.org/10.1186/s12884-022-04391

Morlando M, Collins S. Placenta accreta spectrum disorders: challenges, risks, and management strategies. Int J Womens Health 2020 10; 12: 1033-1045.

https://doi.org/10.2147/IJWH.S224191

Yaqub U, Habib M. Incidence of Placenta Accreta and Association of Booking Status with Maternal Outcomes based on a study in a Tertiary Care Hospital of Rawalpindi. JSOGP 2018; 8(4): 218-222.

Nieto‐Calvache AJ, Palacios‐Jaraquemada JM, Osanan G, Cortes‐Charry R, Aryananda RA, Bangal VB, et al. Lack of experience is a main cause of maternal death in placenta accreta spectrum patients. Acta Obstetricia et Gynecologica Scandinavica 2021; 100(8): 1445-1453.

https://doi.org/10.1111/aogs.14163

Goh WA, Zalud I. Placenta accreta: diagnosis, management and the molecular biology of the morbidly adherent placenta. J.Matern.-Fetal Neonatal Med 2016 2; 29(11)1795-1800.

https://doi.org/ 10.3109/14767058.2015.1064103

Riteau AS, Tassin M, Chambon G, Le Vaillant C, de Laveaucoupet J, Quéré MP, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. PLoS One 2014 14; 9(4): e94866.

https://doi.org/10.1371/journal.pone.0094866

Happe SK, Yule CS, Spong CY, Wells CE, Dashe JS, Moschos E, et al. Predicting Placenta Accreta Spectrum: Validation of the Placenta Accreta Index. J Ultrasound Med 2021; 40(8): 1523-1532.

https://doi.org/10.1002/jum.15530

Khaliq Showman HA, Alizzi FJ, Helmi ZR, Ismael VA, Fawzi HA. Placenta accrete spectrum disorders: A single centre experience over four years in the view of international guidelines. J Pak Med Assoc 2019; 69(Suppl 3)(8): S68-S72.

Ishtiaq S, Malik U, Sultana S, Jadoon A. An audit of primary post-partum hemorrhage at a tertiary care hospital. Pak J Surg 2018; 34(1): 62-66.

Bhal K, Bhal N, Mulik V, Shankar L. The uterine compression suture-a valuable approach to control major haemorrhage at lower segment caesarean section. J obstet and gynaecol 2005 1; 25(1): 10-4.

https://doi.org/10.1080/01443610400022553

Adu‐Bredu TK, Rijken MJ, Nieto‐Calvache AJ, Stefanovic V, Aryananda RA, Fox KA, et al. International Society of Placenta Accreta SPECTRUM (IS‐PAS) Low‐and Middle‐Income Countries Working Group. A simple guide to ultrasound screening for placenta accreta spectrum for improving detection and optimizing management in resource limited settings. Int J Obstet gynaecol 2023; 160(3): 732-741.

https://doi.org/10.1002/ijgo.14376

Agarwal S, Agarwal A, Chandak S. Role of placenta accreta index in prediction of morbidly adherent placenta: A reliability study. Ultrasound 2021; 29(2): 92-99.

https://doi.org/10.1177/1742271X20959742

Tovbin J, Melcer Y, Shor S, Pekar‐Zlotin M, Mendlovic S, Svirsky R, et al. Prediction of morbidly adherent placenta using a scoring system. Ultrasound in Obstet Gynecol 2016; 48(4): 504-510.

https://doi.org/10.1002/uog.15813

Nabhan AE, AbdelQadir YH, Abdelghafar YA, Kashbour MO, Salem N, Abdelkhalek AN, et al. Therapeutic effect of Internal iliac artery ligation and uterine artery ligation techniques for bleeding control in placenta accreta spectrum patients: A meta-analysis of 795 patients. Front Surg 2022 1; 9: 983297.

https://doi.org/10.3389/fsurg.2022.983297

Chandraharan E, Rao S, Belli AM, Arulkumaran S. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet 2012; 117(2): 191-194.

https://doi.org/10.1016/j.ijgo.2011.12.005

Fawcus S. Practical approaches to managing postpartum haemorrhage with limited resources. Best Pract Res Clin Obstet Gynaecol 2019 ; 61(6): 143-155.

https://doi.org/10.1016/j.bpobgyn.2019.03.009

Hussein AM, Dakhly DMR, Raslan AN, Kamel A, Abdel Hafeez A, Moussa M, et al. The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial. J Matern Fetal Neonatal Med 2019; 32(20): 3386-3392.

https://doi.org/10.1080/14767058.2018.1463986

Lin J, Lin F, Zhang Y. Uterine artery ligation before placental delivery during caesarean in patients with placenta previa accreta. Medicine (Baltimore) 2019; 98(36): e16780.

https://doi.org/10.1097/md.0000000000016780

Kasraeian M, Vafaei H, Jahromi MA, Arasteh P, Shahraki HR, Arasteh P, et al. Introducing an efficient model for the prediction of placenta accreta spectrum using the MCP regression approach based on sonography indexes: how efficient is sonography in diagnosing accreta?. BMC pregnancy and childbirth 2020; 20(1): 111.

https://doi.org/10.1186/s12884-020-2799-0