A STUDY ON THE AGREEMENT BETWEEN ANTENATAL DIAGNOSIS OF PLACENTA ACRETA SPECTRUM (PAS) BY ULTRASOUND AND INTRA-OPERATIVE CLINICAL GRADING BY FIGO CORRELATED WITH PATHOLOGY RESULTS

Problem statement:

PAS is a major cause of massive obstetrics hemorrhage and cesarean hysterectomies in the era of global rising of cesarean deliveries. Prenatal ultrasound is the recommended method to evaluate the severity of PAS and choose the surgical option, either cesarean hysterectomy or conservative surgery. Recently, the International Federation of Gynecology and Obstetrics (FIGO) has suggested using intraoperative grading criteria as the main diagnostic tool to assess ‘PAS severity help in choosing the best management option rather than relying on only antenatal ultrasound assessment. There is some controversy among obstetricians whether intraoperative grading of PAS is accurate enough and should be used routinely or only in addition to antenatal diagnosis by ultrasound due to the lack of good evidence to support this additional management.

Methods:

A prospective study was done in 70 pregnant women with placenta previa suspected of PAS who were managed in the PSU PAS Center in southern Thailand between May 2022 and July 2023 Antenatal ultrasound evaluation and grading were done between gestational age 28-34 weeks. The patients underwent surgery between 34-36 weeks following the institution’s protocol by surgeons with > 5 years’ experience in PAS surgery. One of the surgeons in each multi-surgeon operative team was blinded to the antenatal diagnosis results and gave an independent intraoperative grading. After the surgery, the histology results were compared with the antenatal and intraoperative gradings.

Results:

There were 28 (41.2%) cases of placenta previa alone and 40 cases of PAS, 3 placenta accreta (4.4%), 21 placenta increta (30.9%), and 16 placenta percreta (23.5%). All PAS cases had histology results to confirm the diagnoses. The interobserver agreement between antenatal and intraoperative findings using Kappa statistics was 0.78 (95% CI: 0.62-0.93). The interobserver agreement between intraoperative findings and histology was 0.82 (95% CI: 0.68-0.96), and the agreement between antenatal ultrasound and histology grading was 0.72 (95% CI: 0.55-0.89).

Conclusion:

Intraoperative grading by experienced surgeons showed the highest agreement with the histology results and can be used to evaluate the severity of PAS alone or combined with antenatal ultrasound to help choose the appropriate option for surgery.

No disclosure of interest.