Placental 3D Doppler and uterine artery Doppler for predicting adverse outcomes in placenta accreta: a retrospective cohort study.

摘要

BACKGROUND: Placenta accreta spectrum (PAS) poses high maternal morbidity from adverse pregnancy outcomes (APOs), yet uterine artery Doppler has limited predictive value, and the additive role of three‑dimensional power Doppler (3D‑PD) remains unclear. METHODS: A retrospective study was carried out on 180 patients with PAS, who were divided into an APO group (n = 76) and a non-APO (n = 104) group. Placental 3D-PD parameters, including the vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI), as well as uterine artery flow parameters, including the pulsatility index (PI), resistance index (RI) and systolic/diastolic ratio (S/D), were collected and compared between the two groups. Multivariate logistic regression was used to identify independent predictors. Internal validation was performed with 1,000 bootstrap resamples, and calibration was evaluated using the Hosmer-Lemeshow test. The predictive value of each parameter and of a combined model was assessed using receiver operating characteristic curves. RESULTS: The overall incidence of APOs in patients with PAS was 42.22% (76/180). The APO group had higher VI, FI and VFI values but lower PI, RI and S/D values than the non-APO group (all p < 0.05). After adjusting for gestational age at delivery, all six parameters remained independent predictors (p < 0.05). Each single parameter showed only poor predictive value, with AUCs ranging from 0.604 to 0.656. The combined model based on all six parameters demonstrated better predictive ability (AUC = 0.793; 95% confidence interval: 0.726-0.859), with a sensitivity of 83.65% and a specificity of 61.84%. CONCLUSION: APOs in patients with PAS are associated with increased placental vascularisation and reduced uterine artery resistance. The combined model outperforms any single parameter and may aid in early risk stratification. Placenta accreta is a condition where the placenta grows too deeply into the womb. This can cause severe bleeding during birth and other problems for mothers. Predicting which women will have complications helps doctors plan better care and be prepared. In this study, researchers reviewed records of 180 pregnant women with placenta accreta. They used ultrasound to measure blood flow in the placenta and uterine arteries. The goal was to see if these measures could predict serious issues like heavy bleeding or early delivery. Amongst the 180 women, 76 (42%) had complications. Those with complications had higher placental blood flow and lower artery resistance. But no single measure was accurate enough. Combining six measures into one model improved prediction. This model correctly identified 84% of high‑risk women, catching most cases. It also correctly ruled out 62% of low‑risk women, so it was moderately helpful. Even with this limitation, the model can guide doctors to decide who needs closer monitoring and earlier action. This could reduce severe bleeding and other risks, leading to safer labours for mothers with this condition.