Clinical Diagnosis of Placenta Accreta and Clinicopathological Outcomes

Joshua I. Rosenbloom, Jonathan S. Hirshberg, Molly J. Stout, Alison G. Cahill, George A. Macones, Methodius G. Tuuli

Research output: Contribution to journalArticle

Abstract

Objective To investigate the association between the intraoperative diagnosis of placenta accreta at the time of cesarean hysterectomy and pathological diagnosis. Study Design This is a retrospective cohort study of all patients undergoing cesarean hysterectomy for suspected placenta accreta from 2000 to 2016 at Barnes-Jewish Hospital. The primary outcome was the presence of invasive placentation on the pathology report. We estimated predictive characteristics of clinical diagnosis of placenta accreta using pathological diagnosis as the correct diagnosis. Results There were 50 cesarean hysterectomies performed for suspected abnormal placentation from 2000 to 2016. Of these, 34 (68%) had a diagnosis of accreta preoperatively and 16 (32%) were diagnosed intraoperatively at the time of cesarean delivery. Two patients had no pathological evidence of invasion, corresponding to a false-positive rate of 4% (95% confidence interval [CI]: 0.5%, 13.8%) and a positive predictive value of 96% (95% CI: 86.3%, 99.5%). There were no differences in complications among patients diagnosed intraoperatively compared with those diagnosed preoperatively. Conclusion Most patients undergoing cesarean hysterectomy for placenta accreta do have this diagnosis confirmed on pathology. However, since the diagnosis of placenta accreta was made intraoperatively in nearly a third of cesarean hysterectomies, intraoperative vigilance is required as the need for cesarean hysterectomy may not be anticipated preoperatively.

Original languageEnglish (US)
Pages (from-to)124-129
Number of pages6
JournalAmerican journal of perinatology
Volume36
Issue number2
DOIs
StatePublished - Jan 1 2019

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Placenta Accreta
Hysterectomy
Placentation
Confidence Intervals
Pathology
Cohort Studies
Retrospective Studies

Keywords

  • cesarean hysterectomy
  • clinical diagnosis
  • clinicopathological outcomes
  • placenta accreta

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Clinical Diagnosis of Placenta Accreta and Clinicopathological Outcomes. / Rosenbloom, Joshua I.; Hirshberg, Jonathan S.; Stout, Molly J.; Cahill, Alison G.; Macones, George A.; Tuuli, Methodius G.

In: American journal of perinatology, Vol. 36, No. 2, 01.01.2019, p. 124-129.

Research output: Contribution to journalArticle

Rosenbloom, Joshua I. ; Hirshberg, Jonathan S. ; Stout, Molly J. ; Cahill, Alison G. ; Macones, George A. ; Tuuli, Methodius G. / Clinical Diagnosis of Placenta Accreta and Clinicopathological Outcomes. In: American journal of perinatology. 2019 ; Vol. 36, No. 2. pp. 124-129.
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abstract = "Objective To investigate the association between the intraoperative diagnosis of placenta accreta at the time of cesarean hysterectomy and pathological diagnosis. Study Design This is a retrospective cohort study of all patients undergoing cesarean hysterectomy for suspected placenta accreta from 2000 to 2016 at Barnes-Jewish Hospital. The primary outcome was the presence of invasive placentation on the pathology report. We estimated predictive characteristics of clinical diagnosis of placenta accreta using pathological diagnosis as the correct diagnosis. Results There were 50 cesarean hysterectomies performed for suspected abnormal placentation from 2000 to 2016. Of these, 34 (68{\%}) had a diagnosis of accreta preoperatively and 16 (32{\%}) were diagnosed intraoperatively at the time of cesarean delivery. Two patients had no pathological evidence of invasion, corresponding to a false-positive rate of 4{\%} (95{\%} confidence interval [CI]: 0.5{\%}, 13.8{\%}) and a positive predictive value of 96{\%} (95{\%} CI: 86.3{\%}, 99.5{\%}). There were no differences in complications among patients diagnosed intraoperatively compared with those diagnosed preoperatively. Conclusion Most patients undergoing cesarean hysterectomy for placenta accreta do have this diagnosis confirmed on pathology. However, since the diagnosis of placenta accreta was made intraoperatively in nearly a third of cesarean hysterectomies, intraoperative vigilance is required as the need for cesarean hysterectomy may not be anticipated preoperatively.",
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