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Am J Perinatol 2019; 36(02): 124-129
DOI: 10.1055/s-0038-1670635
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Diagnosis of Placenta Accreta and Clinicopathological Outcomes

Joshua I. Rosenbloom
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Jonathan S. Hirshberg
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Molly J. Stout
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Alison G. Cahill
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
George A. Macones
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Methodius G. Tuuli
2   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations 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.
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Publication History

10 January 2018

07 August 2018

Publication Date:
07 September 2018 (online)

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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.

Keywords

placenta accreta - cesarean hysterectomy - clinicopathological outcomes - clinical diagnosis
 

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