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

Amaç: Çalışmamızın amacı, plasenta akreta spektrumu (PAS) şüphesinde, seçilmiş ultrasonografik özellikleri kullanan skorlama sisteminin, PAS ve ciddiyetini tahmin etmedeki rolünü değerlendirmektir. Gereç ve Yöntem: Bu prospektif çalışma Temmuz 2019 ile Ocak 2020 tarihleri arasında, 24-37. gebelik haftalarında PAS şüphesi olan plasenta previa totalis tanılı toplam 27 gebe ile gerçekleştirildi. PAS skoru şu parametrelerle hesaplandı: berrak zon kaybı, plasental lakünlerin sayı, boyutu ve düzenliliği, lakün içinde türbülans akım, uterovezikal veya subplasental hipervaskülarite, köprü damarlar ve önceki sezaryen sayısı. Hastalar PAS skorları ve PAS şiddetine göre gruplara ayrıldı. PAS skorlama sisteminin performansı ROC (Receiver Operating Characteristic) eğrileri değerlendirildi. Bulgular: Toplam 27 hastadan, 7 (%25,9) hastada PAS saptanmadı, 5 (%18,5) hastada akreta, 7 (%25,9) hastada inkreta ve 8 (%29,6) hastada perkreta saptandı. PAS skoru 8'in üzerinde olan grupta, hastaların %86'sında plasenta perkreta mevcuttu. PAS skorları, PAS saptanmayan grupta 2,8±1,4, akreta grubunda 3,6±1,9, inkreta grubunda 5,1±2,4, perkreta grubunda 9,8±1,6 olup perkreta grupbunda istatistiksel olarak daha yüksekti. Anormal plasental invazyonunu öngörmek için optimal PAS skoru 4,5 (%60 duyarlılık, %86 özgüllük), perkretanın inkretadan ayrımında optimal PAS skoru 7,5 (%87,5 duyarlılık, %75 özgüllük) saptandı. Sonuç: Çeşitli ultrason ve klinik özellikleri kombine eden PAS skorlama sistemi, prenatal risk değerlendirmesini ve PAS prediksiyonunu büyük ölçüde iyileştirebilir.

Anahtar Kelimeler:

Plasenta akreta spektrumu, plasenta perkreta, ultrasonografi

A scoring system to predict the placenta accreta spectrum: a prospective study

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.

Keywords:

placenta acreta spectrum, placenta percreta, ultrasonography,

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