Validation of a clinical and sonographic based scoring system for prenatal prediction of morbidly adherent placenta in high risk population

Author(s): Abrar Alsadah

Objective: The aim was to validate three sonographic based scoring system in prediction of MAP in high risk population. Study design: A retrospective cohort study was conducted including pregnant women with previous uterine scar and anterior placenta who had Ultrasound evaluation antenatal and delivered in our center. Using three previously proposed sonographic-based score system published by Tovbin et al, Rac et al, and Gilboa et al to predict MAP, Ultrasound images were reviewed by a junior Maternal Fetal Medicine Specialist blinded to the final pathology report and/ or surgical notes. Parameters assessed, included number of previous cesarean sections, number and size of placental lacunae, obliteration of demarcation between uterus and placenta, location of the placenta and Doppler assessment, etc. Results: 55 pregnant women who met the inclusion criteria were reviewed. Nine (16%) cases of MAP were diagnosed at the time of delivery and all had hysterectomy. 12 MAPS confirmed by pathology and or operative notes; 44 of them had normal placenta. Conclusion: In our cohort study, Tovbin had superior prediction of MAP than the other two scoring system. No difference was found to prediction negative cases of MAP for all three-scoring system and appear to be a useful tool. Larger sample and further statistical analysis should be performed before implementation of scoring system in a routine highrisk patient assessment.