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Diagnosis of Placenta Accreta by Uterine Artery Doppler Velocimetry in Patients With Placenta Previa

 Hee Young Cho  ;  Han Sung Hwang  ;  Inkyung Jung  ;  Yong Won Park  ;  Ja Young Kwon  ;  Young Han Kim 
 JOURNAL OF ULTRASOUND IN MEDICINE, Vol.34(9) : 1571-1575, 2015 
Journal Title
Issue Date
Adult ; Causality ; Comorbidity ; Female ; Humans ; Image Enhancement/methods ; Image Interpretation, Computer-Assisted/methods ; Incidence ; Placenta Accreta/diagnostic imaging* ; Placenta Accreta/epidemiology* ; Placenta Previa/diagnostic imaging* ; Placenta Previa/epidemiology* ; Pregnancy ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment/methods ; Sensitivity and Specificity ; Ultrasonography, Doppler/methods ; Ultrasonography, Doppler/statistics & numerical data* ; Uterine Artery/diagnostic imaging*
obstetric ultrasound ; placenta accreta ; placenta previa ; uterine artery Doppler velocimetry
OBJECTIVES: To evaluate the potential value of uterine artery Doppler velocimetry in diagnosing placenta accreta. METHODS: Clinical records of all deliveries between April 1991 and March 2013 were retrospectively analyzed. Cases of intrauterine growth restriction, pregnancy-induced hypertension, multiple pregnancies, fetal anomalies, chromosomal abnormalities, and maternal medical illnesses such as cardiovascular disease, renal disease, and diabetes mellitus were excluded. A total of 11,210 cases were evaluated, including 403 cases of placenta previa without accreta (placenta previa) and 39 cases of placenta previa with accreta (placenta accreta). All patients underwent uterine artery Doppler velocimetry to measure the mean resistive index and pulsatility index (PI) in the third trimester. The analysis included participant characteristics such as age, parity, abortion history, previous cesarean delivery, gestational age at delivery, neonatal sex, and birth weight. RESULTS: The mean uterine artery PI was significantly lower in the placenta accreta group compared to previa alone (0.51 versus 0.57; P = .002). The odds ratios for placenta accreta were 2.4 for 2 or more previous abortions (P = .011) and 5.3 and 7.0 for 1 and 2 or more previous cesarean deliveries (P = .001 and .005). With an increase in the mean PI by 0.01, the odds ratio for placenta accreta decreased by 0.94 (P < .001). The area under the receive operating characteristic curve was 0.72 for previous cesarean delivery alone, increasing to 0.77 with the combination of the mean PI and previous cesarean delivery (P = .047). CONCLUSIONS: This study suggests that the mean PI measured by uterine artery Doppler velocimetry is reduced in patients with placenta accreta compared to those without accreta. The diagnostic accuracy of placenta accreta can be potentially improved if uterine artery Doppler values and the history of cesarean delivery are combined.
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1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Ja Young(권자영) ORCID logo https://orcid.org/0000-0003-3009-6325
Kim, Young Han(김영한) ORCID logo https://orcid.org/0000-0003-0645-6028
Park, Yong Won(박용원)
Jung, Inkyung(정인경) ORCID logo https://orcid.org/0000-0003-3780-3213
Cho, Hee Young(조희영)
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