DESIGNING A SCORING MODEL FOR PLACENTA ACCRETA PREDICTION : EVALUATING PREDICTION ACCURACY
Main Article Content
Keywords
Placenta accreta spectrum, ultrasound scoring model, diagnostic accuracy, placenta previa, cesarean section, obstetric ultrasound.
Abstract
To evaluate the diagnostic accuracy of a combined clinical and ultrasonographic scoring model for predicting placenta accreta spectrum (PAS) in high-risk pregnancies.
Methods:
This open-label randomized controlled trial conducted at Department of Gynecology and Obstetrics of Jinnah Postgraduate Medical Centre, Karachi from 16 June, 2024 to 17 September, 2024. The research was a prospective cohort study involving 323 pregnant women whose gestation was at least 18 weeks Longo and met preset criteria of PAS risks. The maternal demographics, obstetric history and seven standardized ultrasound parameters were documented. A scoring system (range: 018) was used to categorize women as low-risk (03) and high-risk (4 and above). Statistical analysis comprised of logistic regression and ROC curve analysis with p <0.05 as significant.
Results:
PAS was validated in 68 women (21.1%). Prior caesarean delivery (p <0.001), placenta previa (p <0.001), and a short interpregnancy interval (p = 0.002) were significantly more prevalent in PAS cases. Severe placental lacunae (79.4% vs. 18.4%), myometrial thickness <1 mm (63.2% vs. 8.6%), and marked uterovesical hypervascularity (58.8% vs. 11.4%) exhibited a significant association with PAS (all p <0.001). The scoring model accurately identified 92.6% of PAS cases as high-risk, in contrast to 18.4% of non-PAS cases (p <0.001). Logistic regression identified severe lacunae (OR 5.87), myometrial thinning (OR 4.94), and placenta previa (OR 3.21) as independent predictors. ROC analysis demonstrated exceptional discriminatory capacity, yielding an AUC of 0.92 (95% CI: 0.88–0.96), sensitivity of 92.6%, specificity of 81.5%, positive predictive value of 63.4%, and negative predictive value of 96.9%.
Conclusion:
The combined clinical ultrasound scoring system has a high accuracy in diagnosis to predict PAS, and it has a high sensitivity and discriminative ability. Its systematic, replicable measurement can aid in its earlier discovery, enhanced surgical planning and enhanced maternal outcomes, especially in low resource facilities.
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Dr Shagufta Jabbar
PGR, Department of Gynae & Obs, Jinnah Postgraduate Medical College, Karachi, Pakistan
Dr Saba khan
Associate Professor, Department of Gynae & Obs, Jinnah Postgraduate Medical College, Karachi, Pakistan
Dr Hira Bashir
FCPS, Department of Gynae & Obs, Jinnah Postgraduate Medical College, Karachi, Pakistan
Dr Maria
FCPS, Department of Gynae & Obs, Jinnah Postgraduate Medical College, Karachi, Pakistan
Dr Javeria Qamar
MBBS, House Officer Department of Gynae & Obs, Civil Hospital, Karachi, Pakistan
Dr Jaazba Qamar
Researcher, Department of Gynae & Obs, Jinnah Postgraduate Medical College, Karachi, Pakistan.
