The DIAGNOSTIC ACCURACY OF ULTRASOUND FOR MORBIDLY ADHERENT PLACENTA
Diagnostic Accuracy of Ultrasound for Morbidly Adherent Placenta by Using Placenta Accreta Index keeping per-operative findings as Gold Standard
Keywords:
Morbidly adherent placenta, Placenta Accreta Index, ultrasound, diagnostic accuracyAbstract
Abstract
Objective:
The aim of this cross-sectional validation study was to assess the diagnostic accuracy of ultrasound, using the Placenta Accreta Index (PAI), in detecting morbidly adherent placenta (MAP) in a tertiary care hospital in Pakistan.
Methods:
A total of 81 pregnant women in the third trimester, at risk of developing MAP due to a history of two or more cesarean sections, placenta previa, or prior myomectomy independent of cesarean sections, were included in the study. Gray scale and Doppler ultrasound were performed, and the PAI was calculated. Per-operative findings were considered as the gold standard and compared with ultrasound results. Sensitivity, specificity, and diagnostic accuracy were calculated using a 2x2 contingency table.
Results:
Among the included women, 25 (30.86%) had confirmed MAP based on perioperative findings, with varying degrees of placenta accreta (percreta, accreta, and increta). The ROC curve analysis revealed a PAI cutoff value of 4.37, yielding a sensitivity of 84.00%, specificity of 85.71%, and diagnostic accuracy of 85.19%. Lacunae, bridging vessels, and placenta previa were found to be associated with increased risk of MAP, while decreased myometrial thickness correlated with higher PAI values.
Conclusion:
This study demonstrates that ultrasound, utilizing the PAI, exhibits promising diagnostic accuracy for detecting morbidly adherent placenta in women at risk. The findings support the role of ultrasound as a valuable tool in the diagnosis of MAP, aiding in appropriate management and intervention.
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