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Am J Perinatol 2023; 40(02): 149-154
DOI: 10.1055/s-0041-1728834
Original Article

Placenta Accreta Spectrum: Correlation between FIGO Clinical Classification and Histopathologic Findings

Soroush Aalipour
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Bahram Salmanian
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Karin A. Fox
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Steven Leigh Clark
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Amir A. Shamshirsaz
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Nazlisadat Meshinchi Asl
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Eumenia C. Castro
2   Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Hadi Erfani
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Jimmy Spinoza
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Ahmed Nassr
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Michael A. Belfort
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Alireza A. Shamshirsaz
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Abstract

Objective Placenta accreta spectrum (PAS) covers a wide spectrum of placental adherence/invasion with varied clinical significance. Histopathologic examination is considered the confirmatory gold standard, but is only obtained sometime after definitive treatment. The International Federation of Gynecology and Obstetrics (FIGO) has published a new clinical classification that can be assigned at delivery, and we aimed to investigate the association between this new FIGO classification and histopathology and also to assess its correlation with maternal outcomes.

Study Design We studied a retrospective cohort of 185 patients with histopathologically proven PAS managed at our referral center between September 2012 and January 2019. Two experienced surgeons retrospectively reviewed charts and assigned the FIGO grading based on findings reported at delivery. A third experienced reviewer adjudicated to determine the classification used for final analysis. Categorical outcomes were compared with the use of chi-squared and the Fisher exact test, as appropriate. A multivariate model was designed to adjust outcomes in different FIGO groups for the involvement of a formal multidisciplinary management team.

Results Among 185 patients, there were 41 (22%) placenta accreta, 44 (24%) placenta increta, and 100 (54%) placenta percreta on histopathology. The inter-rater reliability was found to be substantial with Kappa = 0.661 (p < 0.001), and 95% confidence interval (CI): 0.449–0.872. There was a significant association between all histopathology groupings and the FIGO clinical classification (p < 0.001). However, we found no association between FIGO classifications and maternal complications.

Conclusion The new FIGO clinical classification is strongly associated with histopathologic findings. A better understanding of the depth and extent of invasion as afforded by the clinical classification system will help standardize reporting and future research.

Key Points

  • PAS includes a wide spectrum of placental invasion with varied clinical significance.

  • Histopathological examination is considered the confirmatory gold standard.

  • The new FIGO clinical classification is strongly associated with histopathologic findings.

Keywords

placenta accreta spectrum disorder - placenta accreta - morbidly adherent placenta - abnormally invasive placenta - antenatal diagnosis - depth of invasion - multidisciplinary management - FIGO classification

Note

All the authors contributed to the present study.This study was presented at the 2020 Annual Meeting for Society for Maternal Fetal Medicine, Grapevine, Texas.




Publication History

Received: 22 August 2020

Accepted: 02 March 2021

Article published online:
02 May 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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