Sensitivity Level of Placenta Accreta Index (PAI) Score and Placenta Accreta Spectrum (PAS) Stage as Preoperative Diagnostic Tools for Placenta Accreta Spectrum Disorders (PASD) at Haji Adam Malik General Hospital Medan Indonesia

Abstract

Background: The incidence of Placenta Accreta Spectrum Disorders (PASD) increases by 10-fold in 50 years along with the number of cesarean sections. Ultrasound examination using Placenta Accreta Index (PAI) score and Placenta Accreta Spectrum (PAS) stage as a predictor of PASD has been used worldwide at the antenatal screening. The high diagnostic value of these tools will help the physician to diagnose PASD early and minimize the rate of maternal neonatal mortality and morbidity. Objectives: To evaluate the value of PAI score and PAS stage in diagnosing PASD. Methods: This study is a diagnostic test study using the medical records of mothers who gave birth at Haji Adam Malik General Hospital Medan Indonesia between September 2017 to September 2020, who were diagnosed preoperatively as placenta previa suspected PASD through ultrasound examination using PAI score or PAS stage. The results of these two diagnostic tests were compared to clinical diagnostic criteria of PASD from The International Federation of Obstetrics and Gynecology (FIGO) with or without histopathological confirmation. Results: Of the 177 placenta previa cases, there were 142 women with PASD (80.2%). The diagnostic values of PAI score with 4.6 as an optimal cut-off point were 75% sensitivity, 83% specificity, 94% positive predictive values (PPV), and 47% negative predictive values (NPV). The diagnostic values of the PAS stage were 90% sensitivity, 83%, specificity, 96% PPV, and 68% NPV. Conclusion: PAI score and PAS stage have a diagnostic value that looks equally good when used as a diagnostic tool for PASD.