Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;72(Suppl 1):55-60.
doi: 10.1007/s13224-021-01541-7. Epub 2021 Sep 5.

Role of Placenta Accreta Index for Diagnosis of Placenta Accreta Spectrum in High-Risk Patients

Sugandha Bansal  1 , Jyotsna Suri  1 , S K Bajaj  2 , Charanjeet Ahluwalia  3 , Divya Pandey  1 , Pratima Mittal  1
Affiliations

Role of Placenta Accreta Index for Diagnosis of Placenta Accreta Spectrum in High-Risk Patients

Sugandha Bansal et al. J Obstet Gynaecol India. 2022 Aug.

Abstract

Background: Antenatal diagnosis of placenta accreta spectrum (PAS) can ensure multidisciplinary management at center of excellence which can reduce maternal and fetal complications. This can be established by a scoring system which provides a standardized criterion for the diagnosis and management. The objective of our study was to assess the placenta accreta index (PAI) and its individual parameters for diagnosis of PAS in high-risk patients.

Methods: A prospective study was conducted on 71 pregnant women with placenta previa and previous cesarean section. After informed consent, history was taken and ultrasonography was used to calculate the PAI for each patient. Definitive diagnosis was made clinically during cesarean section or by histopathology for those requiring hysterectomy. The data were evaluated using the latest version of Statistical Package for the Social Sciences software.

Results: All ultrasound parameters of placenta accreta index were statistically significant for predicting PAS (p value < 0.001). ROC curve with AUC of 0.87 95% CI of 0.77-0.94 showed that a score of 4.75 was the best cutoff value to diagnose PAS. Out of the 30 patients found to have placental invasion, 22 had a PAI score of more than 4.75. The score was found to have a sensitivity of 73.3%, specificity 95.1%, positive predictive value 91.7%, negative predictive value 83% and diagnostic accuracy 85.9%.

Conclusions: Women with placenta previa and history of previous CS should undergo screening by PAI, and a cutoff value of ≥ 4.75 should be viewed with high index of suspicion for the presence of PAS.

Keywords: Antenatal diagnosis; Placenta accreta; Placenta accreta index; Placenta increta; Placenta percreta; Ultrasound.

PubMed Disclaimer

Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
USG film showing bridging vessels and placental lacunae
Fig. 2
Fig. 2
Operative findings in placenta percreta showing invasion of uterine serosa
Fig. 3
Fig. 3
Receiver operating characteristic curve of placenta accreta index (total score) for predicting placenta accreta spectrum
See this image and copyright information in PMC

References

    1. Jauniaux E, Collins S, Burton GJ. The placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018;218:75–87. doi: 10.1016/j.ajog.2017.05.067. - DOI - PubMed
    1. Mittal P, Suri J, Pruthi N, et al. Comparison of placenta accreta spectrum disorders diagnosed in intrapartum and antepartum period—a three year experience in a tertiary referral unit of India. Eur J Obstet Gynecol Reprod Biol. 2019;236:41–5. doi: 10.1016/j.ejogrb.2019.03.001. - DOI - PubMed
    1. Fan D, Li S, Wu S, et al. Prevalence of abnormally invasive placenta among deliveries in mainland China: a PRISMA-compliant systematic review and meta-analysis. Medicine. 2017;96:6636. doi: 10.1097/MD.0000000000006636. - DOI - PMC - PubMed
    1. Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol. 2015;212:218. doi: 10.1016/j.ajog.2014.08.019. - DOI - PubMed
    1. Silver RM, Fox KA, Barton JR, et al. Center of excellence for placenta accreta. Am J Obstet Gynecol. 2015;212:561–568. doi: 10.1016/j.ajog.2014.11.018. - DOI - PubMed

LinkOut - more resources