PLACENTA ACCRETA INDEX

Dr.dr.Budi Handono SpOG(K).,MH.Kes

BACKGROUND

1 per 500 pregnancies

Antenatal diagnosis

Improve maternal and fetal

outcomes
RISK FACTOR

Gestational
Age Race
age

Previous Uterine
Parity surgical
C-section procedure
TABLE 1.
Demographic characteristics according to histologic evidence of
placental invasion
FIRST LINE DIAGNOSIS

Color
Sonography
with grayscale Doppler
imaging

Confirmation :
histologic evidence of placental invasion
from the hysterectomy specimen
ULTRASOUND location of
placenta

Retroplacental
myometrial
thickness
retroplacental
clear zone
bridging vessels
uterine- between the
bladder placenta
interface
and bladder wall
presence of
intraplacental
lacunar spaces
ULTRASOUND

Echolucent line that

sonographically represents
vascular decidua basalis and
extends entire length of
placenta. The middle arrow
points to area of obliteration
from invading placenta and
smaller 2 arrows show
normal retroplacentalclear
space.

Rac. Placenta Accreta Index. Am J Obstet Gynecol 2015.

 Arrows point to dot-and-dash
appearance of echogenic uterine-
bladder interface. This
irregularity is caused by
abnormal bridging
vasculature that is easily seen
with Doppler
velocimetry.

Rac. Placenta Accreta Index. Am J Obstet Gynecol 2015.

 Normally thick and
echogenic interface is
replaced by ingrowth of
morbidly adherent
placenta (arrows).

Rac. Placenta Accreta Index. Am J Obstet Gynecol 2015.

 Retroplacental myometrium
is thin as result of
abnormal ingrowth of
placenta. Smallest
myometrial thickness in
sagittal plane is measured.
Measurement of smallest
thickness is <1 mm.

Rac. Placenta Accreta Index. Am J Obstet Gynecol 2015.

 Sonolucent areas
throughout placenta that
vary
in size and shape and give
placenta Swiss
cheese appearance. This
patient had >6
lacuna (arrows). They were
large and very
bizarre-appearing
throughout, consistent
with
grade-3 lacunae.
Additionally, no
myometrium
is present between
placenta and
uterinebladder
interface.

Rac. Placenta Accreta Index. Am J Obstet Gynecol 2015.

GRADDING
FINBERG AND WILLIAMS

0 none seen

1 1-3 present and generally small

2
3
Many throughout the placenta and
appearing large and bizarre
 Doppler color mapping
demonstrates abnormal
vasculature that bridges
from placental mass to
uterine-bladder interface
and sometimes
beyond (arrows).

Rac. Placenta Accreta Index. Am J Obstet Gynecol 2015.

TABLE 2.
Ultrasound parameters of entire cohort
TABLE 3.
Placenta Accreta Index score

score of 9

96%
chance of histologic
placental invasion
TABLE 4.
Sensitivity, specificity, and positive and negative predictive values at each PAI
score
 REFERENCES

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Terima Kasih