{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:32Z","timestamp":1787028632614,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science (JSPS) KAKENHI","doi-asserted-by":"publisher","award":["22K16864"],"award-info":[{"award-number":["22K16864"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This study aimed to investigate the diagnostic accuracy of the placenta accreta index (PAI) for predicting placenta accreta spectrum (PAS) in women with placenta previa. We analyzed 33 pregnancies with placenta previa at Keio University Hospital. The PAI was assessed in the early third trimester, and PAS was diagnosed histologically or clinically defined as retained placenta after manual removal attempts. The PAI and incidence of PAS were analyzed. Ten women (30%) were diagnosed with PAS and had higher volumes of perioperative bleeding (p = 0.016), higher rate of requiring uterine artery embolization (p = 0.005), and peripartum hysterectomy (p = 0.0002) than women without PAS. A PAI &gt; 2 was the most useful cut-off point for predicting PAS and was more sensitive than prediction values using traditional evaluation (history of cesarean section and placental location). Post-hoc analysis revealed a higher rate of previous history of cesarean delivery (30% vs. 4.4%, p = 0.038), severe placental lacunae (\u2265grade2) (70% vs. 8.7%, p = 0.0003), thin myometrial thickness (90% vs. 22%, p = 0.0003), anterior placenta (100% vs. 30%, p = 0.0002), and presence of bridging vessels (30% vs. 0%, p = 0.0059) in PAS women. PAI could help predict the outcomes of women with placenta previa with and without a history of cesarean delivery to reduce PAS-induced perinatal complications.<\/jats:p>","DOI":"10.3390\/jcm12031090","type":"journal-article","created":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T01:35:45Z","timestamp":1675128945000},"page":"1090","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Ultrasonographic Prediction of Placental Invasion in Placenta Previa by Placenta Accreta Index"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4069-8824","authenticated-orcid":false,"given":"Keita","family":"Hasegawa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Sinjuku, Tokyo 1608582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3652-5389","authenticated-orcid":false,"given":"Satoru","family":"Ikenoue","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Sinjuku, Tokyo 1608582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuya","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Sinjuku, Tokyo 1608582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maki","family":"Oishi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Sinjuku, Tokyo 1608582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toyohide","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Sinjuku, Tokyo 1608582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Sinjuku, Tokyo 1608582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Clinical Trial and Clinical Epidemiology, University of Tsukuba Faculty of Medicine, 1-1-1 Tennodai, Tsukuba 305-8577, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshifumi","family":"Kasuga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Sinjuku, Tokyo 1608582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daigo","family":"Ochiai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami, Sagamihara 252-0375, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamoru","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Sinjuku, Tokyo 1608582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1002\/uog.1926","article-title":"Antenatal diagnosis of placenta accreta: A review","volume":"26","author":"Comstock","year":"2005","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Committee, Publications (2010). Society for Maternal-Fetal Medicine, Belfort M.A. Placenta accreta. Am. J. Obstet. Gynecol., 203, 430\u2013439.","DOI":"10.1016\/j.ajog.2010.09.013"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.ajog.2019.01.233","article-title":"Prevalence and main outcomes of placenta accreta spectrum: A systematic review and meta-analysis","volume":"221","author":"Jauniaux","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1002\/uog.13194","article-title":"Prenatal identification of invasive placentation using ultrasound: Systematic review and meta-analysis","volume":"42","author":"Iacovella","year":"2013","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"343.e1","DOI":"10.1016\/j.ajog.2014.10.022","article-title":"Ultrasound predictors of placental invasion: The placenta accreta Index","volume":"212","author":"Rac","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1002\/ijgo.12761","article-title":"FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders","volume":"146","author":"Jauniaux","year":"2019","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"146","DOI":"10.31486\/toj.21.0138","article-title":"Evaluation of Antepartum Factors for Predicting the Risk of Emergency Cesarean Delivery in Pregnancies Complicated with Placenta Previa","volume":"22","year":"2022","journal-title":"Ochsner. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1097\/AOG.0000000000002865","article-title":"Association of implementing a multidisciplinary team approach in the management of morbidly adherent placenta with maternal morbidity and mortality","volume":"132","author":"Bartels","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_9","unstructured":"WOMAN Trial Collaborators (2017). Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): An international, randomised, double-blind, placebo-controlled trial. Lancet, 389, 2105\u20132116."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/aogs.13238","article-title":"Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: A systematic review and meta-analysis","volume":"97","author":"Pagani","year":"2018","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"177.e1","DOI":"10.1016\/j.ajog.2014.03.029","article-title":"Accuracy of ultrasound for the prediction of placenta accreta","volume":"211","author":"Bowman","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1002\/jum.15530","article-title":"Predicting placenta accreta spectrum: Validation of the placenta accreta index","volume":"40","author":"Happe","year":"2021","journal-title":"J. Ultrasound Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/01.AOG.0000219750.79480.84","article-title":"Maternal morbidity associated with multiple repeat cesarean deliveries","volume":"107","author":"Silver","year":"2006","journal-title":"Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1111\/j.0001-6349.2005.00832.x","article-title":"Magnetic resonance imaging in 300 cases of placenta accreta: Surgical correlation of new findings","volume":"84","author":"Bruno","year":"2005","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/aogs.13258","article-title":"Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: A systematic review and meta-analysis","volume":"97","author":"Familiari","year":"2018","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1097\/GRF.0000000000000407","article-title":"Imaging of placenta accreta spectrum","volume":"61","author":"Berkley","year":"2018","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"20200267","DOI":"10.1259\/bjr.20200267","article-title":"MRI of placenta accreta: Diagnostic accuracy and impact of interventional radiology on foetal-maternal delivery outcomes in high-risk women","volume":"93","author":"Fiocchi","year":"2020","journal-title":"Br. J. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"618.e1","DOI":"10.1016\/j.ajog.2018.03.013","article-title":"Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders","volume":"218","author":"Einerson","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6644","DOI":"10.1080\/14767058.2021.1918670","article-title":"Prediction of clinical outcomes in women with placenta accreta spectrum using machine learning models: An international multicenter study","volume":"35","author":"Shazly","year":"2022","journal-title":"J. Matern. Fetal. Neonatal. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"193.e1","DOI":"10.1016\/j.ajog.2018.04.049","article-title":"Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta","volume":"219","author":"Marcellin","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","first-page":"545","article-title":"Risk factors for placenta accreta","volume":"93","author":"Hung","year":"1999","journal-title":"Obstet. Gynecol."},{"key":"ref_22","first-page":"266","article-title":"Placenta accreta is associated with elevated maternal serum alpha-fetoprotein","volume":"82","author":"Kupferminc","year":"1993","journal-title":"Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"433.e1","DOI":"10.1016\/j.ajog.2020.03.019","article-title":"Placenta accreta spectrum: Biomarker discovery using plasma proteomics","volume":"223","author":"Shainker","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s43032-020-00319-y","article-title":"Maternal Serum VEGF Predicts Abnormally Invasive Placenta Better Than NT-proBNP: A Multicenter Case-Control Study","volume":"28","author":"Schwickert","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.29271\/jcpsp.2022.12.1570","article-title":"Maternal Serum Cripto-1 Levels in Pregnancies Complicated with Placenta Previa and Placenta Accreta Spectrum (Pas)","volume":"32","author":"Ozkose","year":"2022","journal-title":"J. Coll. Physicians Surg. Pak."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1090\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:20:28Z","timestamp":1760120428000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,31]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12031090"],"URL":"https:\/\/doi.org\/10.3390\/jcm12031090","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,31]]}}}