TY - JOUR
T1 - External validation of and improvement upon a model for the prediction of placenta accreta spectrum severity using prospectively collected multicenter ultrasound data
AU - IS-PAS group
AU - Kolak, Magdalena
AU - Gerry, Stephen
AU - Huras, Hubert
AU - Al Naimi, Ammar
AU - Fox, Karin A.
AU - Braun, Thorsten
AU - Stefanovic, Vedran
AU - van Beekhuizen, Heleen
AU - Morel, Olivier
AU - Paping, Alexander
AU - Bertholdt, Charline
AU - Calda, Pavel
AU - Lastuvka, Zdenek
AU - Jaworowski, Andrzej
AU - Savukyne, Egle
AU - Collins, Sally
AU - Chalubinski, Kinga M.
AU - Kawka-Paciorkowska, Katarzyna
AU - Mhallem Gziri, Mina
AU - Morlando, Maddalena
AU - Chantraine, Frederic
AU - Strindfors, Gita
AU - Bluth, Anja
AU - Hanulikova, Petra
AU - Turan, Ozhan M.
AU - Rubenstein, Andrew
AU - Nieto-Calvache, Albaro Jose
N1 - Publisher Copyright:
© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
PY - 2024
Y1 - 2024
N2 - Introduction: This study aimed to validate the Sargent risk stratification algorithm for the prediction of placenta accreta spectrum (PAS) severity using data collected from multiple centers and using the multicenter data to improve the model. Material and Methods: We conducted a multicenter analysis using data collected for the IS-PAS database. The Sargent model's effectiveness in distinguishing between abnormally adherent placenta (FIGO grade 1) and abnormally invasive placenta (FIGO grades 2 and 3) was evaluated. A new model was developed using multicenter data from the IS-PAS database. Results: The database included 315 cases of suspected PAS, of which 226 had fully documented standardized ultrasound signs. The final diagnosis was normal placentation in 5, abnormally adherent placenta/FIGO grade 1 in 43, and abnormally invasive placenta/FIGO grades 2 and 3 in 178. The external validation of the Sargent model revealed moderate predictive accuracy in a multicenter setting (C-index 0.68), compared to its higher accuracy in a single-center context (C-index 0.90). The newly developed model achieved a C-index of 0.74. Conclusions: The study underscores the difficulty in developing universally applicable PAS prediction models. While models like that of Sargent et al. show promise, their reproducibility varies across settings, likely due to the interpretation of the ultrasound signs. The findings support the need for updating the current ultrasound descriptors and for the development of any new predictive models to use data collected by different operators in multiple clinical settings.
AB - Introduction: This study aimed to validate the Sargent risk stratification algorithm for the prediction of placenta accreta spectrum (PAS) severity using data collected from multiple centers and using the multicenter data to improve the model. Material and Methods: We conducted a multicenter analysis using data collected for the IS-PAS database. The Sargent model's effectiveness in distinguishing between abnormally adherent placenta (FIGO grade 1) and abnormally invasive placenta (FIGO grades 2 and 3) was evaluated. A new model was developed using multicenter data from the IS-PAS database. Results: The database included 315 cases of suspected PAS, of which 226 had fully documented standardized ultrasound signs. The final diagnosis was normal placentation in 5, abnormally adherent placenta/FIGO grade 1 in 43, and abnormally invasive placenta/FIGO grades 2 and 3 in 178. The external validation of the Sargent model revealed moderate predictive accuracy in a multicenter setting (C-index 0.68), compared to its higher accuracy in a single-center context (C-index 0.90). The newly developed model achieved a C-index of 0.74. Conclusions: The study underscores the difficulty in developing universally applicable PAS prediction models. While models like that of Sargent et al. show promise, their reproducibility varies across settings, likely due to the interpretation of the ultrasound signs. The findings support the need for updating the current ultrasound descriptors and for the development of any new predictive models to use data collected by different operators in multiple clinical settings.
KW - abnormal adherent placenta
KW - abnormal invasive placenta
KW - placenta accreta spectrum
KW - prediction model
KW - probability
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U2 - 10.1111/aogs.14941
DO - 10.1111/aogs.14941
M3 - Article
C2 - 39164972
AN - SCOPUS:85201810343
SN - 0001-6349
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
ER -