Tovbin et al reported a score for predicting a morbidly adherence placenta (MAP, placenta accreta, placenta increta, placenta percreta). The authors are from Assaf Harofeh Medical Center and Tel Aviv University in Israel.
Patient selection: pregnancy, typically third trimester
Evaluation: ultrasonography
Parameters:
(1) number of previous cesarean deliveries
(2) maximum dimension of lacuna in cm
(3) number of lacunae
(4) obliteration of the uteroplacental demarcation
(5) location of the placenta
(6) Doppler assessment
Parameter
Finding
Points
number of previous Cesarean deliveries
0
0
1
1
>= 2
2
maximum diameter of lacuna
no lacunae
0
<= 2 cm
1
> 2 cm
2
number of lacunae
no lacunae
0
1 or 2
1
> 2
2
obiliteration of the UP demarcation
no
0
yes
2
location of the placenta
anterior
1
placenta previa
2
other
0
Doppler assessment
blood flow in placental lacunae
1
hypervascularity of placenta-bladder and/or uretero-placental interface
2
other
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• A score >= 8 is associated with a high probability of MAP (84%).
• A score of 6 or 7 indicates moderate probability of MAP (29%).
• A score <= 5 indicates low probability of MAP (< 1%).
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