Bedside risk estimation of morbidly adherent placenta using simple calculator

R. Maymon, Y. Melcer*, M. Pekar-Zlotin, O. Shaked, H. Cuckle, J. Tovbin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To construct a calculator for ‘bedside’ estimation of morbidly adherent placenta (MAP) risk based on ultrasound (US) findings. Materials and methods: This retrospective study included all pregnant women with at least one previous cesarean delivery attending in our US unit between December 2013 and January 2017. The examination was based on a scoring system which determines the probability for MAP. Results: The study population included 471 pregnant women, and 41 of whom (8.7%) were diagnosed with MAP. Based on ROC curve, the most effective US criteria for detection of MAP were the presence of the placental lacunae, obliteration of the utero-placental demarcation, and placenta previa. On the multivariate logistic regression analysis, US findings of placental lacunae (OR = 3.5; 95% CI, 1.2–9.5; P = 0.01), obliteration of the utero-placental demarcation (OR = 12.4; 95% CI, 3.7–41.6; P < 0.0001), and placenta previa (OR = 10.5; 95% CI, 3.5–31.3; P < 0.0001) were associated with MAP. By combining these three parameters, the receiver operating characteristic curve was calculated, yielding an area under the curve of 0.93 (95% CI, 0.87–0.97). Accordingly, we have constructed a simple calculator for ‘bedside’ estimation of MAP risk. The calculator is mounted on the hospital’s internet website (http://www.assafh.org/Pages/PPCalc/index.html). The risk estimation of MAP varies between 1.5 and 87%. Conclusions: The present calculator enables a simple ‘bedside’ MAP estimation, facilitating accurate and adequate antenatal risk assessment.

Original languageEnglish
Pages (from-to)631-635
Number of pages5
JournalArchives of Gynecology and Obstetrics
Volume297
Issue number3
DOIs
StatePublished - 1 Mar 2018

Keywords

  • Calculator
  • Morbidly adherent placenta
  • Prenatal diagnosis
  • Risk estimation
  • Ultrasound

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