Tingkat Sensitivitas Skor Placenta Accreta Index (PAI) dan Stadium Placenta Accreta Spectrum (PAS) Sebagai Diagnosis Preoperatif Placenta Accreta Spectrum Disorders (PASD) dan Luaran Maternal Serta Neonatal di RSUP H. Adam Malik

Abstract

Background: The incidence of Placenta Accreta Spectrum Disorders (PASD), has increased 10-fold in the last 50 years which raised along with the number of Caesarean Sections. Currently, ultrasonography (USG) examination using Placenta Accreta Index (PAI) score and the Placenta Accreta Spectrum (PAS) stage have been widely used as predictors of PASD. Methodology: This is a diagnostic study using medical record of mothers who gave birth at H. Adam Malik Hospital Medan from 1st September 2017 to 30th September 2020 who were diagnosed as placenta previa suspected accreta or PASD through USG using PAI score or PAS stage. The results of these two diagnostic tests were compared with clinical findings during surgery with or without histopathological confirmation. Sensitivity, specificity, positive predictive value and negative predictive value were obtained. The cut-off point of the PAI score from Receiver Operating Curve (ROC) and the accuracy from Area Under the Curve (AUC) were obtained. The p value is considered significant if <0.05 and the confidence interval is 95%. Results: From 177 cases of placenta previa suspected accreta 142 (80,2%) were suffering from PASD. The sensitivity, specificity, positive predictive value, and negative predictive value of the PAI score were 75%, 83%, 94%, and 47% with an optimal cut-off point of PAI score ≥ 4.6, AUC 0.88 (95% CI 0.80-0.95) compare to PAS stage which were 90%, 83%, 96%, and 68% (0.89 accuracy). Majority of patients required hysterectomy (82.4%), required blood transfusion (90.2%), and only 1 mother (0.8%) was dead. The majority of babies were born alive (97.2%) with a mature birth age (54.5%), 9 babies (6.3%) were dead. Conclusion: PAI score and PAS stage have a diagnostic value that were equally good when used as a diagnostic tool for PASD.

Latar Belakang: Insidens Placenta Accreta Spectrum Disorders (PASD) meningkat 10 kali lipat dalam 50 tahun seiring banyaknya Seksio Sesarea. Pemeriksaan USG dengan skor Placenta Accreta Index (PAI) dan stadium Placenta Accreta Spectrum (PAS) sebagai prediktor PASD telah digunakan di dunia untuk skrining kelainan tersebut secara dini. Metodologi: Penelitian ini merupakan penelitian uji diagnostik menggunakan rekam medis ibu yang melahirkan di RSUP H. Adam Malik dari 1 September 2017 sampai 30 September 2020 yang didiagnosis sebagai plasenta previa sangkaan akreta atau PASD melalui pemeriksaan USG dengan skor PAI atau stadium PAS. Hasil kedua tes diagnostik ini dibandingkan dengan temuan klinis operasi dengan atau tanpa hasil histopatologi sehingga didapatkan nilai sensitivitas, spesifisitas, nilai duga positif dan nilai duga negatif. Nilai titik potong skor PAI dari Receiver Operating Curve (ROC) dan tingkat akurasi dari Area Under the Curve (AUC). Nilai p dianggap signifikan apabila < 0,05 dan interval kepercayaan 95%. Hasil: Dari 177 kasus plasenta previa sangkaan akreta, penderita PASD adalah 142 orang (80,2%). Nilai sensitivitas, nilai spesifisitas, nilai duga positif, dan nilai duga negatif PAI dan PAS masing-masing 75%, 83%, 94%, dan 47% (dengan nilai titik potong PAI ≥ 4,6, AUC 0,88 (IK 95% 0,80-0,95)) vs 90%, 83%, 96%, dan 68%(nilai akurasi 0,89). Mayoritas pasien membutuhkan histerektomi (82,4%), memerlukan transfusi (90,2%), hanya 1 orang (0,8%) dinyatakan meninggal. Mayoritas bayi lahir hidup (97,2%), usia kelahiran matur (54,5%) dan 9 bayi (6,3%) meninggal. Kesimpulan: Skor PAI dan stadium PAS memiliki nilai diagnostik yang terlihat sama baiknya apabila digunakan sebagai alat diagnostik PASD.