Implications of Placenta Accreta Index on Management of Patients with Placenta Accreta Spectrum

Abstract

Objective: To determine the implications of placenta accreta index on management of patients with placenta accreta spectrum.

Methodology: A total of 200 patients with history of at least 1 previous cesarean were included. The study was conducted in Islamabad based private clinic setup. Antenatal obstetric ultrasound, was done for placental localization, presence of lacunae, bridging vessels and retroplacental myometrial thickness. Placenta accreta index (PAI) was used for high risk as a sum of scores for PAI parameters is calculated. The cumulative score of PAI parameters ranging between 0-3 were regarded as low risk, 4-5 as medium risk and >6 as high risk. Data was collected via study proforma and analysis was done by using SPSS version 20.

Results: A total of 200 patients were studied and their average age corresponds to 33 years. Out of all, 35% cases fall in low-risk category, 40% fall in medium risk category, and 25% cases were attributed to high-risk category. 58.5 % patients had history of previous 2 or more cesarean deliveries and 17 patients having prior cesarean deliveries. 35 patients having low risk for placenta accreta showed grade 2 lacunae, 75 patients from medium risk group shows grade 2 lacunae whereas 20 patients from high risk also show grade 2 lacunae. 30 patients from high-risk group showed grade 3 lacunae.

Conclusion: The timely diagnosis of placental adherence in terms of high PAI score allows the obstetrician to optimize the patients care and provide for preemptive management plan for patients.