Agreement of intraoperative clinical grading by the FIGO criteria with antenatal ultrasound diagnosis of placenta accreta spectrum and correlation with clinical outcomes.

BACKGROUND

Placenta accreta spectrum (PAS) is a serious obstetric condition characterized by abnormal invasion of placental tissue into the uterine wall, leading to severe maternal complications. Early and accurate diagnosis, both antenatally and intraoperatively, is crucial for effective management and for reducing associated morbidity and mortality.

OBJECTIVE

The primary objective is to evaluate agreement between intraoperative clinical grading using the FIGO 2018 criteria of PAS and antenatal ultrasound diagnoses, and the secondary objective to assess the correlation between clinical outcomes and postpartum histopathological findings.

STUDY

DESIGN

In this prospective study, we enrolled 70 pregnant women with placenta previa suspected of having PAS, who were managed at an accredited PAS Center from September 2022 to July 2023. Antenatal ultrasound evaluations were performed in the third trimester, and patients underwent surgery between 34 and 36+6 weeks. The experienced surgeons assessed the intraoperative PAS grading using the FIGO 2018 criteria. Postoperatively, antenatal and intraoperative PAS grading were compared with histopathological findings. The agreement between antepartum and intraoperative grading, along with their correlations with clinical outcomes, was analyzed using kappa statistics.

RESULTS

Twenty-eight patients (40%) had isolated placenta previa. Forty-two (60%) had PAS, including six with accreta (8.6%), 15 with increta (21.4%), and 21 with percreta (30%). Cesarean hysterectomy was performed in 39 (92.9%) of PAS and had confirmed with histopathological examination. The kappa agreement between ultrasound diagnosis and intraoperative grading was substantial (kappa=0.88; 95% confidence interval [CI]: 0.64-0.94). The agreement between intraoperative grading and histopathology was moderate (kappa=0.68; 95% CI: 0.40-0.91).

CONCLUSION

Antenatal ultrasound diagnoses and intraoperative clinical grading of PAS demonstrated a high level of concordance. Although antenatal ultrasound enables early preparation and correlation well with histopathology and clinical outcomes, intraoperative assessment remains crucial for accurately determining PAS severity and guiding surgery.