INTRODUCTION: This study aimed to validate the Sargent risk stratification algorithm for the prediction of placenta accreta spectrum (PAS) severity using data collected from multiple centers and using the multicenter data to improve the model. MATERIAL AND METHODS: We conducted a multicenter analysis using data collected for the IS-PAS database. The Sargent model's effectiveness in distinguishing between abnormally adherent placenta (FIGO grade 1) and abnormally invasive placenta (FIGO grades 2 and 3) was evaluated. A new model was developed using multicenter data from the IS-PAS database. RESULTS: The database included 315 cases of suspected PAS, of which 226 had fully documented standardized ultrasound signs. The final diagnosis was normal placentation in 5, abnormally adherent placenta/FIGO grade 1 in 43, and abnormally invasive placenta/FIGO grades 2 and 3 in 178. The external validation of the Sargent model revealed moderate predictive accuracy in a multicenter setting (C-index 0.68), compared to its higher accuracy in a single-center context (C-index 0.90). The newly developed model achieved a C-index of 0.74. CONCLUSIONS: The study underscores the difficulty in developing universally applicable PAS prediction models. While models like that of Sargent et al. show promise, their reproducibility varies across settings, likely due to the interpretation of the ultrasound signs. The findings support the need for updating the current ultrasound descriptors and for the development of any new predictive models to use data collected by different operators in multiple clinical settings.

Centre for Statistics in Medicine University of Oxford Oxford UK

Department of Gynecological Oncology Erasmus MC Cancer Center Rotterdam The Netherlands

Department of Gynecology Obstetrics and Neonatology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Obstetrics and Gynecology Buergerhospital Frankfurt Germany

Department of Obstetrics and Gynecology CHRU Nancy Université de Lorraine Nancy France

Department of Obstetrics and Gynecology Fetomaternal Medical Center Helsinki University Hospital and University of Helsinki Berlin Finland

Department of Obstetrics and Perinatology Medical College Jagiellonian University Krakow Poland

Department of Obstetrics Charité Universitätsmedizin Berlin Freie Universität Berlin and Humboldt Universität zu Berlin Berlin Germany

Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Baylor College of Medicine Houston Texas USA

Division of Obstetrics and Maternal Fetal Medicine Department of Obstetrics and Gynecology University Hospital Frankfurt Goethe University Frankfurt Germany

Hospital of Lithuanian University of Health Sciences Kaunas Clinics Lithuanian University of Health Sciences Kaunas Lithuania

IADI INSERM Université de Lorraine Nancy France

Nuffield Department of Women's and Reproductive Health University of Oxford Oxford UK

Zobrazit více v PubMed

Obstetric care consensus no. 7: Placenta accreta spectrum. Obstet Gynecol. 2018;132:e259‐e275. PubMed

Jauniaux E, Chantraine F, Silver RM, Langhoff‐Roos J. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int J Gynaecol Obstet. 2018;140:265‐273. PubMed

Jauniaux E, Ayres‐de‐Campos D. FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction. Int J Gynaecol Obstet. 2018;140:261‐264. PubMed

Collins SL, Alemdar B, van Beekhuizen HJ, et al. Evidence‐based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 2019;220:511‐526. PubMed

Pain FA, Dohan A, Grange G, et al. Percreta score to differentiate between placenta accreta and placenta percreta with ultrasound and MR imaging. Acta Obstet Gynecol Scand. 2022;101:1135‐1145. PubMed PMC

Rac MW, Dashe JS, Wells CE, Moschos E, McIntire DD, Twickler DM. Ultrasound predictors of placental invasion: the Placenta Accreta Index. Am J Obstet Gynecol. 2015;212(343):e1‐e7. PubMed

Maymon R, Melcer Y, Pekar‐Zlotin M, Shaked O, Cuckle H, Tovbin J. Bedside risk estimation of morbidly adherent placenta using simple calculator. Arch Gynecol Obstet. 2018;297:631‐635. PubMed

Tovbin J, Melcer Y, Shor S, et al. Prediction of morbidly adherent placenta using a scoring system. Ultrasound Obstet Gynecol. 2016;48:504‐510. PubMed

Gao Y, Gao X, Cai J, et al. Prediction of placenta accreta spectrum by a scoring system based on maternal characteristics combined with ultrasonographic features. Taiwan J Obstet Gynecol. 2021;60:1011‐1017. PubMed

Fratelli N, Prefumo F, Maggi C, et al. Third‐trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study. Ultrasound Obstet Gynecol. 2022;60:381‐389. PubMed PMC

Shazly SA, Hortu I, Shih JC, et al. Prediction of clinical outcomes in women with placenta accreta spectrum using machine learning models: an international multicenter study. J Matern Fetal Neonatal Med. 2022;35:6644‐6653. PubMed

Sargent W, Gerry S, Collins SL. A risk‐prediction model for placenta Accreta Spectrum severity from standardized ultrasound markers. Ultrasound Med Biol. 2023;49:512‐519. PubMed

Collins SL, Ashcroft A, Braun T, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 2016;47:271‐275. PubMed

Jauniaux E, Bhide A, Kennedy A, Woodward P, Hubinont C, Collins S. FIGO consensus guidelines on placenta accreta spectrum disorders: prenatal diagnosis and screening. Int J Gynaecol Obstet. 2018;140:274‐280. PubMed

Jauniaux E, Ayres‐de‐Campos D, Langhoff‐Roos J, Fox KA, Collins S. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146:20‐24. PubMed

Moons KG, Altman DG, Reitsma JB, Collins GS. New guideline for the reporting of studies developing, validating, or updating a multivariable clinical prediction model: the TRIPOD Statement. Adv Anat Pathol. 2015;22:303‐305. PubMed

Agarwal S, Agarwal A, Chandak S. Role of placenta accreta index in prediction of morbidly adherent placenta: a reliability study. Ultrasound. 2021;29:92‐99. PubMed PMC

Singh S, Carusi DA, Wang P, et al. External validation of a multivariable prediction model for placenta Accreta Spectrum. Anesth Analg. 2023;137:537‐547. PubMed

Maurea S, Verde F, Romeo V, et al. Prediction of placenta accreta spectrum in patients with placenta previa using a clinical, US and MRI combined model: a retrospective study with external validation. Eur J Radiol. 2023;168:111116. PubMed

Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med. 1992;11:333‐343. PubMed

Philips J, Gurganus M, DeShields S, et al. Prevalence of sonographic markers of placenta Accreta Spectrum in low‐risk pregnancies. Am J Perinatol. 2019;36:733‐780. PubMed

Braun T, van Beekhuizen HJ, Morlando M, Morel O, Stefanovic V. Developing a database for multicenter evaluation of placenta accreta spectrum. Acta Obstet Gynecol Scand. 2021;100(Suppl 1):7‐11. PubMed