DIAGNOSIS AND MANAGEMENT CHALLENGES OF PLACENTA ACCRETA SPECTRUM DISORDERS

Authors

  • Iustina Petra SOLOMON-CONDRIUC ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • A. CARAULEANU ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • Adina Elena TANASE ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • R. M. POPOVICI ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • Raluca Anamaria MOGOS ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • Raluca Ștefana BRAN ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • G. V. TANASE ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • Claudia Florida COSTEA ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • Demetra Gabriela SOCOLOV ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • Daniela Maria TANASE ‟Grigore Popa” University of Medicine and Pharmacy Iași
  • A. I. CUCU
  • G. ROIU University of Oradea, Romania

Abstract

Placenta accreta spectrum (PAS) disorders are associated with significant maternal and neonatal morbidity and mortality. The primary aim of this study was to determine the diagnostic accuracy of individual and combined ultrasound markers for predicting PAS disorders and to report the intraoperative complication rates for this category of patients. The secondary aim of this study was to reflect the clinical challenges of a case diagnosed with placenta accreta. Materials and methods: We conducted a retrospective analysis of clinical and ultrasound data from 52 pregnant patients with or without confirmed PAS disorders who gave birth in a tertiary center. Univariate analysis was used to compare differences in baseline characteristics between groups. We calculated the diagnostic accuracy of ultrasound signs for PAS disorders and the complication rates in these patients. Results: Placental lacunar spaces had a sensitivity of 83.87%, a specificity of 76.19%, and an accuracy of 80.77% for predicting PAS disorder. The best predictive performance for predicting PAS disorders was achieved when using at least three ultrasound markers, with a sensitivity of 90.32%, a specificity of 85.71%, and an accuracy of 88.46%. Urinary tract injuries were the most frequently encountered complications in patients with confirmed PAS. Conclusions: Better antenatal diagnosis of this pathology will reduce the surgical risk and improve the overall outcome for both mother and fetus.

Author Biographies

  • Iustina Petra SOLOMON-CONDRIUC, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Mother and Child Medicine

  • A. CARAULEANU, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Mother and Child Medicine

  • Adina Elena TANASE, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Mother and Child Medicine

  • R. M. POPOVICI, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Mother and Child Medicine

  • Raluca Anamaria MOGOS, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
     Department of Mother and Child Medicine

  • Raluca Ștefana BRAN, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Doctoral School

  • G. V. TANASE, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Surgery (II)

  • Claudia Florida COSTEA, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Surgery (II)

  • Demetra Gabriela SOCOLOV, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Mother and Child Medicine

  • Daniela Maria TANASE, ‟Grigore Popa” University of Medicine and Pharmacy Iași

    Faculty of Medicine
    Department of Surgery (II)

  • A. I. CUCU

    Ștefan cel Mare” University of Suceava, Romania
    Faculty of Medicine and Biological Sciences

  • G. ROIU, University of Oradea, Romania

    Faculty of Medicine and Pharmacy

References

1. Bloomfield V, Rogers S, Leyland N. Placenta accreta spectrum. Cmaj 2020; 192(34): E980 / doi:10.1503/cmaj.200304.

2. O’Connor D, Berndl A. Placenta percreta. Cmaj 2018; 190(6), E168 / doi:10.1503/cmaj.171411.

3. Aggarwal R, Suneja A, Vaid NB, Yadav P, Sharma A, Mishra K. Morbidly adherent placenta: a critical review. J Obstet Gynaecol India 2012; 62(1): 57-61 / doi:10.1007/s13224-012-0149-5.

4. Carauleanu A, Tanasa IA, Nemescu D, Haba R, Socolov D. Vaginal birth after Cesarean experience in Romania: a retrospective case-series study and online survey. Exp Ther Med 2021; 22(2): 894 / doi:10.3892/etm.2021.10326.

5. Moradi B, Azadbakht J, Sarmadi S, Gity M, Shirali E, Azadbakht M. Placenta accreta spectrum in early and late pregnancy from an imaging perspective. A scoping review. Radiologia (Engl Ed) 2023; 65(6): 531-545 / doi:10.1016/j.rxeng.2023.02.001.

6. Capannolo G, D’Amico A, Alameddine S, Di Girolamo R, Khalil A, Calì G, et al. Placenta accreta spectrum disorders clinical practice guidelines: a systematic review. J Obstet Gynaecol Res 2023; 49(5): 1313-1321 / doi:10.1111/jog.15544.

7. Jauniaux E, Hussein AM, Fox KA, Collins SL. New evidence-based diagnostic and management strategies for placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol 2019; 61: 75-88 / doi:10.1016/j.bpobgyn.2019.04.006.

8. Morlando M, Collins S. Placenta Accreta Spectrum Disorders: Challenges, Risks, and Management Strategies. Int J Womens Health 2020; 12: 1033-1045 / doi:10.2147/ijwh.S224191.

9. Collins SL, Alemdar B, van Beekhuizen HJ, et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Inva-sive Placenta. Am J Obstet Gynecol 2019; 220(6): 511-526 / doi:10.1016/j.ajog.2019.02.054.

10. Matsuo K, Sangara RN, Matsuzaki S, et al. Placenta previa percreta with surrounding organ involve-ment: a proposal for management. Int J Gynecol Cancer 2023; 33(10):1633-1644 / doi:10.1136/ijgc-2023-004615.

11. Clausen C, Lönn L, Langhoff-Roos J. Management of placenta percreta: a review of published cases. Acta Obstet Gynecol Scand 2014; 93(2) 138-143 / doi:10.1111/aogs.12295.

12. Hawkins R, Evans M, Hammond S, Hartopp R, Evans E. Placenta accreta spectrum disorders - Peri-operative management: the role of the anesthetist. Best Pract Res Clin Obstet Gynaecol 2021; 72: 38-51 / doi:10.1016/j.bpobgyn.2020.08.003.

13. Susanu C, Hărăbor A, Vasilache IA, Harabor V, Călin AM. Predicting Intra- and Postpartum Hemor-rhage through Artificial Intelligence. Medicina (Kaunas) 2024; 60(10):1604 / doi:10.3390/medicina60 101604.

14. Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, Fox KA, Collins S. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2019; 146(1): 20-24 / doi:10.1002/ijgo.12761.

15. Patel-Lippmann KK, Planz VB, Phillips CH, et al. Placenta Accreta Spectrum Disorders: Update and Pictorial Review of the SAR-ESUR Joint Consensus Statement for MRI. Radiographics 2023; 43(5): e220090 / doi:10.1148/rg.220090.

16. Yu FNY, Leung KY. Antenatal diagnosis of placenta accreta spectrum (PAS) disorders. Best Pract Res Clin Obstet Gynaecol 2021; 72: 13-24 / doi:10.1016/j.bpobgyn.2020.06.010.

17. 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 / doi:10.1111/j.1600-0412. 2011.01147.x.

18. Haba RM, Pristavu AI, Cobzeanu ML, et al. Predicting Placenta Accreta Spectrum Disorders in a Cohort of Pregnant Patients in the North-East Region of Romania-Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging. Diagnostics (Basel) 2022; 12(9): 2130 / doi:10.3390/diagnostics 1209 2130.

19. Pătru CL, Marinaş MC, Tudorache Ş, et al. The performance of hyper adherence markers in anterior placenta praevia overlying the Caesarean scar. Rom J Morphol Embryol 2019; 60(3): 861-867. PMID: 31912097

20. Stănculescu RV, Brătilă E, Socolov DG, et al. Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam - literature review and authors’ experience. Rom J Morphol Embryol 2022; 63(2): 293-305 / doi:10.47162/rjme.63.2.02.

21. Jauniaux E,D’Antonio F, Bhide A, et al. Modified Delphi study of ultrasound signs associated with placenta accreta spectrum. Ultrasound Obstet Gynecol 2023; 61(4): 518-525 / doi:10.1002/uog.26155.

22. Enste R, Cricchio P, Dewandre PY, et al. Placenta Accreta Spectrum Part II: hemostatic considerations based on an extended review of the literature. J Perinat Med 2023; 51(4): 455-467 / doi:10.1515/jpm-2022-0233.

23. Pagani G, Cali G, Acharya G, et al. Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018; 97(1): 25-37 / doi:10.1111/aogs.13238.

24. Cali G, Forlani F, Lees C, Timor-Tritsch I, Palacios-Jaraquemada J, Dall’Asta A, et al. Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound Obstet Gynecol 2019; 53(6): 752-760 / doi:10.1002/uog.20246.

25. Dall’Asta A, Calì G, Forlani F, et al. Evaluation of perioperative complications using a newly described staging system for placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol 2020; 250: 54-60 / doi:10.1016/j.ejogrb.2020.04.038.

26. Covali R, Socolov D, Carauleanu A, Paval, et al. The Importance of the Novel Postpartum Uterine Ultrasonographic Scale in Numerical Assessments of Uterine Involution Regarding Perinatal Maternal and Fetal Outcomes. Diagnostics (Basel) 2021; 11(9):1731 / doi:10.3390/diagnostics11091731.

27. Sargent W, Gerry S, Collins SL. A Risk-Prediction Model for Placenta Accreta Spectrum Severity from Standardized Ultrasound Markers. Ultrasound Med Biol 2023; 49(2): 512-519 / doi:10.1016/j.ultras medbio.2022.09.021.

28. Skupski DW, Duzyj CM, Scholl J, et al. Evaluation of classic and novel ultrasound signs of placenta accreta spectrum. Ultrasound Obstet Gynecol 2022; 59(4): 465-473 / doi:10.1002/uog.24804.

29. Timpau AS, Miftode RS, Costache II, et al. An Overview of the Impact of Bacterial Infections and the Associated Mortality Predictors in Patients with COVID-19 Admitted to a Tertiary Center from Eastern Europe. Antibiotics (Basel) 2023; 12(1): 144 / doi:10.3390/antibiotics12010144.

30. Savin ML, Mihai F, Gheorghe L, et al. Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy. Medicina (Kaunas) 2021; 57(7):650 / doi:10.3390/medicina57070650.

31. Costan VV, Ciocan-Pendefunda CC, Ciofu ML, et al. Balancing orbital volume reduction and redis-tribution for a tailored surgical treatment in Graves’ ophthalmopathy. Graefes Arch Clin Exp Oph-thalmol 2020; 258(10): 2313-23202313-2320 / doi:10.1007/s00417-020-04807-4.

32. Galesanu C, Buzduga C, Florescu A, Moisii L, Ciubotaru V. Diabetes mellitus, chronic complication in patients with acromegaly: case report and review of the literature. Med Surg J - Rev Med Chir Soc Med Nat Iasi 2015; 119 (1): 92-96.

33. Radu VD, Pristavu AI, Vinturache A, et al. Risk Factors for Urological Complications Associated with Caesarean Section-A Case-Control Study. Medicina (Kaunas) 2022; 58(1):123 / doi:10.3390/medicina58010123.

34. Radu VD, Costache RC, Onofrei P, et al. Multidrug-Resistant (MDR) Urinary Tract Infections Asso-ciated with Gut Microbiota in CoV and Non-CoV Patients in a Urological Clinic during the Pandemic: A Single Center Experience. Antibiotics (Basel) 2023; 12(6): 973 / doi:10.3390/antibiotics12060973.

35. Balan R, Radu VD, Giușcă SE, et al. A Rare Cause of Massive Hematuria: Placenta Percreta With Bladder Invasion. In Vivo 2021; 35(6): 3633-3639 / doi:10.21873/invivo.12670.

36. Lucidi A, Jauniaux E, Hussein AM, et al. Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2023; 62(5): 633-643 / doi:10.1002/uog.26299.

37. Covali R, Socolov D, Socolov R, Pavaleanu I, Carauleanu A, Akad M,et al. Complete Blood Count Peculiarities in Pregnant SARS-CoV-2-Infected Patients at Term: A Cohort Study. Diagnostics (Basel) 2021; 12(1):80 / doi:10.3390/diagnostics12010080.

38. Covali R, Socolov D, Pavaleanu I, Carauleanu A, Boiculese VL, Socolov R. SARS-CoV-2 Infection Susceptibility of Pregnant Patients at Term Regarding ABO and Rh Blood Groups: A Cohort Study. Medicina (Kaunas) 2021; 57(5):499 / doi:10.3390/ medicina 57050499.

39. Socolov R, Akad M, Păvăleanu M, et al. The Rare Case of a COVID-19 Pregnant Patient with Quad-ruplets and Postpartum Severe Pneumonia. Case Report and Review of the Literature. Medicina (Kaunas) 2021; 57(11):1186 / doi:10.3390/medicina57111186.

40. Edu A, Teodorescu C, Dobjanschi CG, et al. Placenta changes in pregnancy with gestational diabetes. Rom J Morphol Embryol 2016; 57(2): 507-512.

41. Covali R, Socolov D, Socolov R. Coagulation tests and blood glucose before vaginal delivery in healthy teenage pregnant women compared with healthy adult pregnant women. Medicine (Baltimore) 2019; 98(5): e14360 / doi:10.1097/md.0000000000014360.

42. Giuseppe C, Salvatore P, Federica C, et al. Urinary tract injuries during surgery for placenta accreta spectrum disorders. European Journal of Obstetrics & Gynecology and Reproductive Biology 2023; 287: 93-96 / doi:10.1016/j.ejogrb.2023.05.036.

43. Shamshirsaz AA, Fox KA, Erfani H, et al. Coagulopathy in surgical management of placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol 2019; 237: 126-130 / doi:10.1016/j.ejogrb.2019.04.026.

44. Abi Habib P, Goetzinger K, Turan OM. Placenta accreta spectrum conservative management and coagulopathy: case series and systematic review. Ultrasound Obstet Gynecol 2024; 63(6): 731-737 / doi:10.1002/uog.27547.

45. Biele C, Kaufner L, Schwickert A, et al. Conservative management of abnormally invasive placenta complicated by local hyperfibrinolysis and beginning disseminated intravascular coagulation. Arch Gynecol Obstet 2021; 303 (1): 61-68 / doi:10.1007/s00404-020-05721-0.

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Published

2024-12-23

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Vol. 128 No. 4 (2024): The Medical-Surgical Journal

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