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DOI: 10.1055/s-0038-1670635
Clinical Diagnosis of Placenta Accreta and Clinicopathological Outcomes
Funding This work was supported by the National Institutes of Health (grant numbers UL1 TR000448 and P30 CA091842). Dr. Tuuli is supported by U01HD077384–03 and 1R01HD086007–01 grants. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health. The funder had no role in the study design, collection, analysis, or interpretation of data, in the writing of the report, or in the decision to submit the article for publication.Publikationsverlauf
10. Januar 2018
07. August 2018
Publikationsdatum:
07. September 2018 (online)
Abstract
Objective To investigate the association between the intraoperative diagnosis of placenta accreta at the time of cesarean hysterectomy and pathological diagnosis.
Study Design This is a retrospective cohort study of all patients undergoing cesarean hysterectomy for suspected placenta accreta from 2000 to 2016 at Barnes-Jewish Hospital. The primary outcome was the presence of invasive placentation on the pathology report. We estimated predictive characteristics of clinical diagnosis of placenta accreta using pathological diagnosis as the correct diagnosis.
Results There were 50 cesarean hysterectomies performed for suspected abnormal placentation from 2000 to 2016. Of these, 34 (68%) had a diagnosis of accreta preoperatively and 16 (32%) were diagnosed intraoperatively at the time of cesarean delivery. Two patients had no pathological evidence of invasion, corresponding to a false-positive rate of 4% (95% confidence interval [CI]: 0.5%, 13.8%) and a positive predictive value of 96% (95% CI: 86.3%, 99.5%). There were no differences in complications among patients diagnosed intraoperatively compared with those diagnosed preoperatively.
Conclusion Most patients undergoing cesarean hysterectomy for placenta accreta do have this diagnosis confirmed on pathology. However, since the diagnosis of placenta accreta was made intraoperatively in nearly a third of cesarean hysterectomies, intraoperative vigilance is required as the need for cesarean hysterectomy may not be anticipated preoperatively.
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References
- 1 Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177 (01) 210-214
- 2 ACOG Committee on Obstetric Practice. ACOG Committee opinion. Number 266, January 2002: placenta accreta. Obstet Gynecol 2002; 99 (01) 169-170
- 3 Belfort MA. ; Publications Committee, Society for Maternal-Fetal Medicine. Placenta accreta. Am J Obstet Gynecol 2010; 203 (05) 430-439
- 4 Bailit JL, Grobman WA, Rice MM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015; 125 (03) 683-689
- 5 Thurn L, Lindqvist PG, Jakobsson M. , et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2016; 123 (08) 1348-1355
- 6 Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG 2014; 121 (01) 62-70
- 7 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 (02) 218.e1-218.e9
- 8 Eller AG, Bennett MA, Sharshiner M. , et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117 (2 Pt 1): 331-337
- 9 Silver RM, Fox KA, Barton JR. , et al. Center of excellence for placenta accreta. Am J Obstet Gynecol 2015; 212 (05) 561-568
- 10 Bowman ZS, Eller AG, Kennedy AM. , et al. Accuracy of ultrasound for the prediction of placenta accreta. Am J Obstet Gynecol 2014; 211 (02) 177.e1-177.e7
- 11 Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2017; 217 (01) 27-36
- 12 Palacios Jaraquemada JM, Bruno CH. Magnetic resonance imaging in 300 cases of placenta accreta: surgical correlation of new findings. Acta Obstet Gynecol Scand 2005; 84 (08) 716-724
- 13 Warshak CR, Eskander R, Hull AD. , et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006; 108 (3 Pt 1): 573-581
- 14 Warshak CR, Ramos GA, Eskander R. , et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 2010; 115 (01) 65-69
- 15 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 16 Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand 2011; 90 (10) 1140-1146
- 17 Jauniaux E, Silver RM. Moving from intra partum to prenatal diagnosis of placenta accreta: a quarter of a century in the making but still a long road to go. BJOG 2017; 124 (01) 96
- 18 Obstetric Care Consensus No. Obstetric Care Consensus No. 2: levels of maternal care. Obstet Gynecol 2015; 125 (02) 502-515
- 19 Nageotte MP. Always be vigilant for placenta accreta. Am J Obstet Gynecol 2014; 211 (02) 87-88