title: Diagnosis of Placenta Accreta by Uterine Artery Doppler Velocimetry in Patients With Placenta Previa.
abstract: OBJECTIVE
  To evaluate the potential value of uterine artery Doppler velocimetry in diagnosing placenta accreta.
  
  
  METHODS
  Clinical records of all deliveries between April 1991 and March 2013 were retrospectively analyzed. Cases of intrauterine growth restriction, pregnancy-induced hypertension, multiple pregnancies, fetal anomalies, chromosomal abnormalities, and maternal medical illnesses such as cardiovascular disease, renal disease, and diabetes mellitus were excluded. A total of 11,210 cases were evaluated, including 403 cases of placenta previa without accreta (placenta previa) and 39 cases of placenta previa with accreta (placenta accreta). All patients underwent uterine artery Doppler velocimetry to measure the mean resistive index and pulsatility index (PI) in the third trimester. The analysis included participant characteristics such as age, parity, abortion history, previous cesarean delivery, gestational age at delivery, neonatal sex, and birth weight.
  
  
  RESULTS
  The mean uterine artery PI was significantly lower in the placenta accreta group compared to previa alone (0.51 versus 0.57; P = .002). The odds ratios for placenta accreta were 2.4 for 2 or more previous abortions (P = .011) and 5.3 and 7.0 for 1 and 2 or more previous cesarean deliveries (P = .001 and .005). With an increase in the mean PI by 0.01, the odds ratio for placenta accreta decreased by 0.94 (P < .001). The area under the receive operating characteristic curve was 0.72 for previous cesarean delivery alone, increasing to 0.77 with the combination of the mean PI and previous cesarean delivery (P = .047).
  
  
  CONCLUSIONS
  This study suggests that the mean PI measured by uterine artery Doppler velocimetry is reduced in patients with placenta accreta compared to those without accreta. The diagnostic accuracy of placenta accreta can be potentially improved if uterine artery Doppler values and the history of cesarean delivery are combined.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (H.Y.C., Y.W.P., J.-Y.K., Y.H.K.); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University College of Medicine, Seoul, Korea (H.S.H.); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (I.J.).
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Cho
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (H.Y.C., Y.W.P., J.-Y.K., Y.H.K.); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University College of Medicine, Seoul, Korea (H.S.H.); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (I.J.).
authors.forename: Han Sung
authors.initials: HS
authors.lastname: Hwang
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (H.Y.C., Y.W.P., J.-Y.K., Y.H.K.); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University College of Medicine, Seoul, Korea (H.S.H.); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (I.J.).
authors.forename: Inkyung
authors.initials: I
authors.lastname: Jung
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (H.Y.C., Y.W.P., J.-Y.K., Y.H.K.); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University College of Medicine, Seoul, Korea (H.S.H.); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (I.J.).
authors.forename: Yong Won
authors.initials: YW
authors.lastname: Park
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (H.Y.C., Y.W.P., J.-Y.K., Y.H.K.); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University College of Medicine, Seoul, Korea (H.S.H.); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (I.J.).
authors.forename: Ja-Young
authors.initials: JY
authors.lastname: Kwon
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (H.Y.C., Y.W.P., J.-Y.K., Y.H.K.); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Konkuk University College of Medicine, Seoul, Korea (H.S.H.); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (I.J.) yhkim522@yuhs.ac.
authors.forename: Young Han
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000328:Adult; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D015994:Incidence; D010921:Placenta Accreta / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D010923:Placenta Previa / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011247:Pregnancy; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods / Q000706:statistics & numerical data*; D055988:Uterine Artery / Q000000981:diagnostic imaging*
keywords: obstetric ultrasound; placenta accreta; placenta previa; uterine artery Doppler velocimetry