title: Prediction of morbidly adherent placenta using a scoring system.
abstract: OBJECTIVE
  To evaluate the accuracy of an ultrasound-based scoring system for diagnosing morbidly adherent placenta (MAP).
  
  
  METHODS
  This study included pregnant women referred to our ultrasound unit during 2013-2015 because of suspected MAP on a previous ultrasound examination or because they had at least one previous Cesarean delivery. All women were assessed using a scoring system based on the following: number and size of placental lacunae; obliteration of the demarcation between the uterus and placenta; placental location; color Doppler signals within placental lacunae; hypervascularity of the placenta-bladder and/or uteroplacental interface zone; and number of previous Cesarean deliveries. Each criterion was assigned 0, 1 or 2 points and the sum of points yielded the final score. Patients were classified into low, moderate or high probability for MAP based on the final score. The presence of MAP was determined by the surgeon at delivery and clinical descriptions were documented in the electronic patient file. Pathological diagnoses were available only in cases that underwent hysterectomy.
  
  
  RESULTS
  In total, 258 pregnant women were included in the study, of whom 23 (8.9%) were diagnosed with MAP. There was a statistically significant difference in the prevalence of MAP when women were grouped according to the scoring system, with 0.9%, 29.4% and 84.2% in the low, moderate and high probability groups, respectively (P < 0.0001). All sonographic criteria of the scoring system were significantly associated with MAP (P < 0.0001). Receiver-operating characteristics (ROC) curves for prediction of MAP using the number of placental lacunae and obliteration of the uteroplacental demarcation yielded an area under the ROC curve of 0.94 (95% CI, 0.86-1.00).
  
  
  CONCLUSIONS
  Our proposed scoring system is highly predictive of MAP in patients at risk. This allows an adequate multidisciplinary team approach for the planning and timing of delivery in such cases. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Tovbin
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Melcer
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Shor
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Pekar-Zlotin
authors.affiliation: Department of Pathology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Mendlovic
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Svirsky
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel. maymonrb@bezeqint.net.
authors.forename: R
authors.initials: R
authors.lastname: Maymon
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D010921:Placenta Accreta / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011247:Pregnancy; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: Doppler; morbidly adherent placenta; prenatal diagnosis; scoring system; ultrasound