{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T12:37:31Z","timestamp":1793709451672,"version":"4.6.1"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T00:00:00Z","timestamp":1557100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To develop a prenatal ultrasound staging system for placenta accreta spectrum (PAS) disorders in women with placenta previa and to evaluate its association with surgical outcome, placental invasion and the clinical staging system for PAS disorders proposed by the International Federation of Gynecology and Obstetrics (FIGO).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a secondary retrospective analysis of prospectively collected data from women with placenta previa. We classified women according to the following staging system for PAS disorders, based upon the presence of ultrasound signs of PAS in women with placenta previa: PAS0, placenta previa with no ultrasound signs of invasion or with placental lacunae but no evidence of abnormal uterus\u2013bladder interface; PAS1, presence of at least two of placental lacunae, loss of the clear zone or bladder wall interruption; PAS2, PAS1 plus uterovescical hypervascularity; PAS3, PAS1 or PAS2 plus evidence of increased vascularity in the inferior part of the lower uterine segment potentially extending into the parametrial region. We explored whether this ultrasound staging system correlates with surgical outcome (estimated blood loss (EBL, mL), units of packed red blood cells (PRBC), fresh frozen plasma (FFP) and platelets (PLT) transfused, operation time (min), surgical complications defined as the occurrence of any damage to the bladder, ureters or bowel, length of hospital stay (days) and admission to intensive care unit (ICU)) and depth of placental invasion. The correlation between the present ultrasound staging system and the clinical grading system proposed by FIGO was assessed. Prenatal and surgical management were not based on the proposed prenatal ultrasound staging system. Linear and multiple regression models were used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two\u2010hundred and fifty\u2010nine women were included in the analysis. Mean EBL was 516\u2009\u00b1\u2009151\u2009mL in women with PAS0, 609\u2009\u00b1\u2009146\u2009mL in those with PAS1, 950\u2009\u00b1\u2009190\u2009mL in those with PAS2 and 1323\u2009\u00b1\u2009533\u2009mL in those with PAS3, and increased significantly with increasing severity of PAS ultrasound stage. Mean units of PRBC transfused were 0.05\u2009\u00b1\u20090.21 in PAS0, 0.10\u2009\u00b1\u20090.45 in PAS1, 1.19\u2009\u00b1\u20091.11 in PAS2 and 4.48\u2009\u00b1\u20092.06 in PAS3, and increased significantly with PAS stage. Similarly, there was a progressive increase in the mean units of FFP transfused from PAS1 to PAS3 (0.0\u2009\u00b1\u20090.0 in PAS1, 0.25\u2009\u00b1\u20091.0 in PAS2 and 3.63\u2009\u00b1\u20092.67 in PAS3). Women presenting with PAS3 on ultrasound had significantly more units of PLT transfused (2.37\u2009\u00b1\u20092.40) compared with those with PAS0 (0.03\u2009\u00b1\u20090.18), PAS1 (0.0\u2009\u00b1\u20090.0) or PAS2 (0.0\u2009\u00b1\u20090.0). Mean operation time was longer in women with PAS3 (184\u2009\u00b1\u200932\u2009min) compared with those with PAS1 (153\u2009\u00b1\u200938\u2009min) or PAS2 (161\u2009\u00b1\u200928\u2009min). Similarly, women with PAS3 had longer hospital stay (7.4\u2009\u00b1\u20092.1 days) compared with those with PAS0 (3.4\u2009\u00b1\u20090.6 days), PAS1 (6.4\u2009\u00b1\u20091.3 days) or PAS2 (5.9\u2009\u00b1\u20090.8 days). On linear regression analysis, after adjusting for all potential confounders, higher PAS stage was associated independently with a significant increase in EBL (314 (95% CI, 230\u2013399) mL per one\u2010stage increase; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), units of PRBC transfused (1.74 (95% CI, 1.33\u20132.15) per one\u2010stage increase; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), units of FFP transfused (1.19 (95% CI, 0.61\u20131.77) per one\u2010stage increase; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), units of PLT transfused (1.03 (95% CI, 0.59\u20131.47) per one\u2010stage increase; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), operation time (38.8 (95% CI, 31.6\u201346.1) min per one\u2010stage increase; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and length of hospital stay (0.83 (95% CI, 0.46\u20131.27) days per one\u2010stage increase; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). On logistic regression analysis, increased severity of PAS was associated independently with surgical complications (odds ratio, 3.14 (95% CI, 1.36\u20137.25); <jats:italic>P<\/jats:italic> = 0.007), while only PAS3 was associated with admission to the ICU (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). All women with PAS0 on ultrasound were classified as having Grade\u20101 PAS disorder according to the FIGO grading system. Conversely, of the women presenting with PAS1 on ultrasound, 64.1% (95% CI, 48.4\u201377.3%) were classified as having Grade\u20103, while 35.9% (95% CI, 22.7\u201351.6%) were classified as having Grade\u20104 PAS disorder, according to the FIGO grading system. All women with PAS2 were categorized as having Grade\u20105 and all those with PAS3 as having Grade\u20106 PAS disorder according to the FIGO system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Ultrasound staging of PAS disorders is feasible and correlates with surgical outcome, depth of invasion and the FIGO clinical grading system. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20246","type":"journal-article","created":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T05:36:04Z","timestamp":1551764164000},"page":"752-760","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":130,"title":["Prenatal ultrasound staging system for placenta accreta spectrum disorders"],"prefix":"10.1002","volume":"53","author":[{"given":"G.","family":"Cali","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital  Palermo Italy"},{"name":"Department of Obstetrics and Gynaecology Azienda Ospedaliera Villa Sofia Cervello  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Forlani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arnas Civico Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2104-5561","authenticated-orcid":false,"given":"C.","family":"Lees","sequence":"additional","affiliation":[{"name":"Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital Imperial College Healthcare NHS Trust  London UK"},{"name":"Department of Surgery and Cancer Imperial College London, London  UK"},{"name":"Department of Development and Regeneration KU Leuven, Leuven  Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9774-3107","authenticated-orcid":false,"given":"I.","family":"Timor\u2010Tritsch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Division of Maternal\u2010Fetal Medicine New York University School of Medicine  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Palacios\u2010Jaraquemada","sequence":"additional","affiliation":[{"name":"Centre for Medical Education and Clinical Research (CEMIC) University Hospital  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7201-0206","authenticated-orcid":false,"given":"A.","family":"Dall'Asta","sequence":"additional","affiliation":[{"name":"Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital Imperial College Healthcare NHS Trust  London UK"},{"name":"Department of Surgery and Cancer Imperial College London, London  UK"},{"name":"Department of Medicine and Surgery, Obstetrics and Gynecology Unit University of Parma, Parma  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2393-7501","authenticated-orcid":false,"given":"A.","family":"Bhide","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Division of Developmental Sciences St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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