Prenatal Ultrasonic Grading Of Placenta Accreta Spectrum Disorders And Its Clinical Value

Objective: to put forward the Prenatal ultrasonic grading of placenta accreta spectrum disorders(PAS),and to explore the relationship between this grading with the PAS clinical classification proposed by International Federation of Gynecology and Obstetrics(FIGO)in 2018,and to evaluate its correlation with pregnancy outcome and whether it has clinical value.Methods: the clinical data,prenatal ultrasound diagnosis results and prenatal ultrasound images of singleton pregnancy diagnosed with PAS in our hospital from January 2004 to December 2019 were analyzed retrospectively.according to the standardized term PAS put forward by the European working Group on abnormal placental accreta in 2018,PAS prenatal ultrasound was divided into four grades:PAS1,no abnormal placental ultrasound signs or only abnormal placental lacunae;PAS2,two or more abnormal placental lacunae,Loss of the “clear zone”,Bladder wall interruption,at least two of the three signs;PAS3,PAS1+ Subplacental hypervascularity;PAS4: PAS1 or PAS2+increased blood vessels below the lower segment of the uterus,extending to the para-uterine area.The pregnant women were graded according to the intrapartum records and the PAS clinical grade proposed by FIGO in 2018.To explore the relationship between PAS prenatal ultrasound grade and clinical grade,and to analyze the relationship between PAS prenatal ultrasound grade and pregnancy outcome by Logistic regression and linear regression.Results:(1)204 pregnant women with PAS,PAS172 was diagnosed by prenatal ultrasound,with a diagnosis rate of 84.3%(172 / 204),of which 40 cases underwent hysterectomy;32 cases were missed by ultrasound,of which 5cases underwent hysterectomy(4 cases missed diagnosis because the placenta was completely located in the posterior wall,and 1 case missed the anterior wall placental PAS),due to the poor acoustic condition of abdominal fat thickness.The other 27 cases had a good pregnancy outcome.(2)The relationship between PAS prenatal ultrasound grading and FIGO clinical grade: PAS1 grade 44 cases(39.6%),FIGO2 grade 59 cases(53.2%);PAS2 grade 62 cases,including FIGO3 grade 53cases(85.5%);PAS320 cases,including 7 cases of FIGO4 grade(35.0%)and 7cases of FIGO5 grade(35.0%);PAS411 cases,of which 9 cases were FIGO6 grade(81.8%).The PAS prenatal ultrasound grading is consistent with the FIGO clinical grading.The higher the PAS grade is,the higher the FIGO grade is,and the more serious the placental accreta is.(3)The correlation between PAS prenatal ultrasound grading with pregnancy outcome: the average blood loss during delivery,average operation time,operative complications and hysterectomy rate increased with the increase of prenatal ultrasound grading.In linear regression analysis,the effect of PAS prenatal ultrasound grading on blood loss and operation time was statistically significant(P < 0.001).In Logistic regression analysis,PAS prenatal ultrasound grading was independently correlated with hysterectomy(P < 0.001),and the risk of hysterectomy increased by 4.750 times.(4)The birth status of newborns at all levels according to PAS prenatal ultrasound grading: the 5min score of Apgar score of newborns with PAS1 grade was higher than that of other groups,and the difference was statistically significant(P < 0.05.There was no significant difference in the average birth weight of newborns(P > 0.05).Conclusion: there is a good consistency between PAS prenatal ultrasound grading proposed in this study with FIGO clinical grading.The higher the classification,the more serious the placental accreta,the worse the pregnancy outcome,and can uniformly and standardize the use of PAS-related audio-visual terms,which has good clinical application value.