Journal of Obstetric and Gynaecological Practices POGS

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Related articles

VOLUME 1 , ISSUE 2 ( July-December, 2023 ) > List of Articles

Original Article

Correlation of Placenta Accreta Spectrum Ultrasound Score and the International Federation of Gynecology and Obstetrics Clinical Grading in Placenta Accreta Spectrum Incidence at H. Adam Malik General Hospital, Medan

Andri Hamonangan Sipahutar, Muara Panusunan Lubis, Muhammad Fidel Ganis Siregar, Makmur Sitepu, Henry Salim Siregar, Muhammad Rusda Harahap

Keywords : Cesarean section, Cervical, Childbirth, Fetus, High-risk pregnancy, Maternal, Placenta, Placenta accreta, Placenta accreta spectrum, Pregnancy

Citation Information : Sipahutar AH, Lubis MP, Siregar MF, Sitepu M, Siregar HS, Harahap MR. Correlation of Placenta Accreta Spectrum Ultrasound Score and the International Federation of Gynecology and Obstetrics Clinical Grading in Placenta Accreta Spectrum Incidence at H. Adam Malik General Hospital, Medan. J Obstet Gynaecol 2023; 1 (2):33-41.

DOI: 10.5005/jogyp-11012-0013

License: CC BY-NC 4.0

Published Online: 24-11-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: Placenta accreta spectrum (PAS) is a general term used to describe the clinical condition when part of the placenta, or the entire placenta, invades the uterine wall making it difficult to separate. One of the methods to grade this disorder is the International Federation of Gynecology and Obstetrics (FIGO) grading system which helps in determining the nature and severity of PAS disorders. The PAS ultrasound grading was performed via transvaginal and transabdominal ultrasonography (in all cases) according to the guidelines for ultrasonographic (USG) detection of PAS using the following USG signs, loss of clear zone, placenta lacunae, bladder wall disorders, uterovesical hypervascularity, and increased vascularity of the parametrial region. Aim and objective: To determine the relationship between PAS ultrasound score and FIGO clinical grading on the incidence of PAS disorders at H. Adam Malik General Hospital, Medan, Indonesia. Materials and methods: Patient identity and secondary data were obtained from medical records. The PAS ultrasound score data was taken from transabdominal ultrasonography and transvaginal ultrasonography records. The FIGO clinical grading data collection was based on operative field findings. Some sections of the uterus and placenta were submitted to the anatomical pathology laboratory for histopathological examination to assess the involvement of the placenta invading the uterine wall. Finally, the correlation between the FIGO grading and PAS ultrasound score was calculated using SPSS software. Results: The results showed that there was a significant relationship between the length of operation (p = 0.042; p > 0.05); curettage history (p = 0.231; p > 0.05); the amount of bleeding (p = 0.16; p > 0.05); gestational age at delivery (p = 0.384; p > 0.05); upper arm circumference (UAC) (all) (p = 0.295; p > 0.05); parity (p = 0.133; p > 0.05); and history of placenta accreta (p = 0.761; p > 0.05) with PAS score. There was a significant relationship between the amount of bleeding and arterial ligation with a value of p = 0.011 (p < 0.05) where the majority of patients who underwent ligation experienced bleeding of 2000−3000 cc compared to those who did not undergo the ligation procedure with bleeding below 2000 cc. The FIGO score frequency distribution was 17 people (34.7%) at stage I; 14 people (28.6%) at stage II; 9 people (18.4%) at stage IIIa; 6 people (12.2%) at stage IIIb; and 3 people (6.1%) were at stage IIIc. On the contrary, for PAS score found 7 people (14.3%) at stage 0; 22 people (44.9%) at stage I; 16 people (32.7%) at stage II; and 4 people (8.2%) at stage III. The Kolmogorov–Smirnov normality test showed that the PAS score and FIGO score data were not normally distributed (p < 0.05). After conducting the Chi-square test to assess the relationship between the FIGO score and the PAS score, a p-value of 0.000 was found; this value indicates that there is a significant relationship between the PAS score and the FIGO score (p < 0.001). Based on the presence of USG signs of impaired PAS, 57.9% [95% confidence interval (CI): 51.6–64.0%; 150/259] of women were classified as PAS 0, 15.1% (95% CI: 11, 2–19.9; 39/259) as PAS 1, 6.2% (95% CI: 3.8–9.8; 16/259) as PAS 2, and 20.8% (95% CI: 18, 2–26.4; 54/259) as PAS 3. Conclusion: In this study, it was found that there was a significant relationship between PAS score and FIGO clinical grading in the incidence of PAS abnormalities.


HTML PDF Share
  1. Committee On Obstetric Practice. Committee opinion No. 529: Placenta accreta. Obstet Gynecol 2012;120(1):207–211. DOI: 10.1097/AOG.0b013e318262e340.
  2. Aryananda RA. Resurgence of placenta accreta in Indonesia opinion: Resurgence of placenta accreta in Indonesia. Maj Obs Gin 2018;26(3):98–99. DOI: 10.20473/mog.V26I32018.98-99.
  3. Dwi PS. Analisis Kejadian Plasenta Akreta Di Rsup H. Adam Malik Medan Tahun 2016–2019. Available at: http://Repositori.Usu.Ac.Id/Handle/123456789/25050 2019. Accessed on: 14 July 2021.
  4. Zhang D, Siqin Y, Yanyan H, et al. Risk Factors, Outcome and management survey of PAS disorders in 153 cases: A five-year experience from a hospital of Shanghai, China. Int J Clin Exp Med 2017;10(8):12509–12516.
  5. Jauniaux E, Chantraine F, Silver RM, et al. FIGO placenta accreta diagnosis and management expert consensus panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int J Gynaecol Obstet 2018;140(3):265–273. DOI: 10.1002/Ijgo.12407.
  6. Cali G, Forlani F, Lees C, et al. Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound Obstet Gynecol 2019;53(6):752–760. DOI: 10.1002/uog.20246.
  7. Fitzpatrick KE, Sellers S, Spark P, et al. Incidence and risk factors for placenta accreta/increta/percreta in the UK: A national case–control study. PloS One 2012;7(12):e52893. DOI: 10.1371/journal.pone.0052893.
  8. Negro VD, Aleksa N, Galli C, et al. Ultrasonographic diagnosis of placenta accreta spectrum (PAS) disorder: Ideation of an ultrasonographic score and correlation with surgical and neonatal outcomes. Diagnostics (Basel) 2020;11(1):23. DOI: 10.3390/diagnostics11010023.
  9. Orgul G, Ayhan SG, Saracoglu GC, et al. Is it possible to predict massive bleeding in nulliparous women with placenta previa? Rev Bras Ginecol Obstet 2021;43(1):9–13. DOI: 10.1055/s-0040-1721355.
  10. Fard MB, Kasraeian M, Vafaei H, et al. Introducing an efficient model for the prediction of placenta accreta spectrum using the MCP regression approach based on sonography indexes: How efficient is sonography in diagnosing accreta? BMC Pregnancy Childbirth 2020;20(1):111. DOI: 10.1186/s12884-020-2799-0.
  11. Lumbanraja SN, Yaznil MR, Siahaan AM. The effectiveness of the USG PAS score in detecting the outcome of the placenta accreta spectrum. Ann Gynecol Obstetr Res 2020;3(1):1018.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.