An Ultrasound Scoring Model for the Prediction of Intrapartum Morbidly Adherent Placenta and Maternal Morbidity: A Cross-Sectional Study

Abstract

Objective To design an ultrasound scoring model for the prediction of the intrapartum morbidly adherent placenta (MAP) and maternal morbidity.

Patients and Methods 114 females with singleton pregnancies ≥ 28 weeks of gestation referred for suspicion of MAP were included. All patients underwent examination by two-dimensional ultrasound with the color Doppler setting. Five signs were evaluated: the retroplacental echolucent space, placental lacunae, the hyperechoic uterine-bladder interface, retroplacental myometrium thickness, and subplacental, uterine serosa-bladder wall, intraplacental and bladder wall vascularity. We designed a score ranging from 0–8.5 points, including the five signs according to their odds ratios and evaluated its prediction for MAP and maternal morbidity.

Results Using multivariate logistic regression, all ultrasound signs were significant dependent predictors for both MAP and maternal morbidity (myometrium thickness < 1 mm followed by lacunae ≥ 4 and lost retroplacental echolucent space). The only independent predictors for MAP were myometrium thickness < 1 mm and lacunae ≥ 4, while myometrium thickness < 1 mm and lost retroplacental echolucent space were predictive for maternal morbidity. The score showed a perfect agreement with MAP and a good one for maternal morbidity.

Conclusion Application of the score we designed can improve the ultrasound diagnosis of MAP and the maternal outcome.

Zusammenfassung

Ziel Entwurf eines Ultraschall-Scoring-Modells zur Vorhersage der abnorm invasiven Plazenta („morbidly adherent placenta“, MAP) und der mütterlichen Morbidität.

Patienten und Methoden Eingeschlossen wurden 114 Frauen mit Einlingsschwangerschaften ≥ 28. Schwangerschaftswoche, die wegen Verdacht auf MAP überwiesen wurden. Bei allen Patienten wurde eine 2-dimensionale Ultraschalluntersuchung mit Farbdoppler durchgeführt. 5 Zeichen wurden bewertet: Der echogene retroplazentare Raum, die plazentaren Lakunen, die hyperechogene Grenze von Uterus zu Blase, die retroplazentare Myometriumdicke und eine Vaskularisation subplazentar von uteriner Serosa zu Blasenwand und intraplazentar zur Blasenwand. Wir entwarfen einen Score zwischen 0 und 8,5 Punkten, einschließlich der 5 Zeichen gemäß ihrer Odds-Ratios, und bewerteten deren Vorhersage für MAP und mütterliche Morbidität.

Ergebnisse Unter Verwendung der multivariaten logistischen Regression waren alle Ultraschallzeichen signifikant abhängige Prädiktoren für sowohl die MAP als auch für die mütterliche Morbidität (Myometriumdicke < 1 mm, gefolgt von Lakunen ≥ 4 und Verlust des echogenen retroplazentaren Raums). Die einzigen unabhängigen Prädiktoren für MAP waren die Myometriumdicke < 1 mm und Lakunen ≥ 4, während es für die mütterliche Morbidität die Myometriumdicke < 1 mm und der Verlust des echogenen retroplazentaren Raums waren. Der Score zeigte eine perfekte Übereinstimmung mit MAP und eine gute mit der mütterlichen Morbidität.

Schlussfolgerung Der Einsatz unseres entwickelten Scores kann die Ultraschalldiagnose der MAP und das mütterliche Outcome verbessern.

Key words

morbidly adherent placenta - ultrasound score - maternal morbidity

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