کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
2757803 1567522 2013 7 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Outcomes of prospectively-collected consecutive cases of antenatal-suspected placenta accreta
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیهوشی و پزشکی درد
پیش نمایش صفحه اول مقاله
Outcomes of prospectively-collected consecutive cases of antenatal-suspected placenta accreta
چکیده انگلیسی

BackgroundAccurate diagnosis of placenta accreta is tentative before surgery. This study developed a predictive score for antenatal diagnosis of placenta accreta through mathematical modeling using clinical signs.MethodsAntenatal cases of suspected placenta accreta were collected prospectively in a single-site tertiary delivery center. Women with clinical signs of placenta accreta (placenta previa, number of previous cesarean deliveries and/or ultrasound suspicion of placenta accreta) were included. The diagnosis of accreta was confirmed surgically. The primary endpoint was the proportion of surgically-diagnosed placenta accreta among all suspected cases. Logistic regression modeling was performed to assess preoperative risk factors for placenta accreta. The risk score was tested on a receiver operator characteristic curve to identify subjects with placenta accreta and the optimum cut-point was chosen.ResultsOver nine years, 92 suspected accreta cases were identified from 46 623 deliveries (0.2%). The diagnosis was confirmed at surgery in 52/92 cases (56%) and there were no maternal deaths. Blood transfusion requirements were greater in patients with placenta accreta versus patients without placenta accreta (median 7 [range 0–25, interquartile range 3–10] versus 0 [0–6, 0–2] units of blood, P <0.0001). Area under the curve of the receiver operator characteristic curve was 0.846, with contribution from three variables (placenta previa, number of previous cesarean deliveries and ultrasound suspicion), each with a P value <0.05. From the ROC curve a cut-point with 100% sensitivity and specificity 25% (95% CI 12.69%–41.20%) was achieved, compared with 86.6% sensitivity (95% CI 74.21%–94.41%) and 60.0% specificity (95% CI 43.33%–75.14%) using ultrasound alone.ConclusionsCombining diagnostic features associated with placenta accreta through mathematical modeling has better positive predictive value than ultrasound alone.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: International Journal of Obstetric Anesthesia - Volume 22, Issue 4, November 2013, Pages 273–279
نویسندگان
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