Diagnostic tests of placenta accreta index score (PAIS) as supporting prenatal diagnosis and outcomes of maternal neonatal in abnormally invasive placenta management at general hospital of Hasan Sadikin Bandung

Abstract

Background: The incidence of abnormally invasive placenta increases tenfold as the number of caesarian section increases in the past 50 years. Placenta previa accreta is strongly associated with massive bleeding and leads to maternal death. Prenatal diagnosis helps in planning the delivery to reduce the risk of bleeding and possible complications. This study aims to find out diagnostic value of Placenta Accreta Index Score (PAIS) as supporting tool in prenatal diagnostic of abnormally invasive placenta.Methods: The diagnostic test was undertaken in May 2017 at General Hospital of Hasan Sadikin, identifying patients with placenta previa with history of caesarian section between May 2016-May 2017. PAIS were obtained and compared with histopathological findings.Results: Among 21 placenta previa patients with post caesarian section, 10 (47.6%) of them histopathologically proven as abnormally invasive placenta. With statistical analysis accuracy values obtained PAIS and histopathological findings in patient with placenta previa is 0.762 (good). Diagnostic value of PAIS with histopathological findings in placenta previa patient had a sensitivity 70%, a specificity 81,8%, positive predictive value (PPV) 77.8%, and negative predictive value (NPV) 75% by PAIS cut off point is 3.125. No maternal death. Mean duration of postoperative care was 5 days. Average total bleeding during surgery is 2622 ml with lowest postoperative hemoglobin 8.36g/dl. All babies born with appropriate to gestational birth weight with average first minute APGAR was 7 and without fetal anemia.Conclusions: PAIS can be used to help to predict the risk of abnormally.