title: A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta.
abstract: OBJECTIVE
  The purpose of this study was to evaluate a novel sonographic scoring system for risk assessment of complications in patients suspected of having morbidly adherent placenta.
  
  
  METHODS
  This retrospective study evaluated the association between maternal complications and a grayscale sonographic scoring system for adherent placenta before surgery. Criteria for adherent placenta included uteroplacental and uterobladder demarcation lines and the presence of lacunae. Placentas were classified into 4 stages: stage 0, normal placentation; stage 1, low probability of adherence; stage 2, moderate possibility of adherence; and stage 3, high suspicion of adherence. Placental adherence as assessed by a surgical team, estimated blood loss, and postoperative hospitalization days were determined for each group, as well as the rates of the need for packed blood cells, cryoprecipitate units, and hysterectomy.
  
  
  RESULTS
  One hundred nine women were included in the study. Twenty-six (23.8%) women were given a score of stage 0, 22 (20.2%) stage 1, 28 (25.7%) stage 2, and 33 (30.3%) stage 3. Linear regression analysis demonstrated that the sonographic staging was the only variable significantly associated with the number of packed cells or cryoprecipitate units transfused (P< .001) and a clinical diagnosis of adherent placenta (P< .001). In addition, both sonographic staging and a history of cesarean delivery were significantly associated with hysterectomy (P = .01; P = .03, respectively), treatment with any blood products (P< .001; P= .01), and the duration of postoperative hospitalization (P< .001; P = .006).
  
  
  CONCLUSIONS
  A scoring system based on simple grayscale parameters may be effective for antenatal risk assessment of maternal complications in cases of suspected morbidly adherent placenta.
authors: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. yinon-si@inter.net.il yinongilboa@gmail.com.
authors: Yinon
authors: Y
authors: Gilboa
authors: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Maya
authors: M
authors: Spira
authors: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Shali
authors: S
authors: Mazaki-Tovi
authors: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Eyal
authors: E
authors: Schiff
authors: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Eyal
authors: E
authors: Sivan
authors: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Reuven
authors: R
authors: Achiron
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010922:Placenta Diseases / Q000000981:diagnostic imaging*; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016216:Ultrasonography, Prenatal
keywords: adherent placenta; obstetric complications; obstetric ultrasound; prenatal diagnosis; sonographic staging