Archives of Gynecology and Obstetrics

, Volume 300, Issue 3, pp 783–791 | Cite as

Scoring system for the prediction of the severity of placenta accrete spectrum in women with placenta previa: a prospective observational study

  • Li Luo
  • Qiulei Sun
  • Demei Ying
  • Xiaohua Wu
  • Ping Yan
  • Ying Yang
  • Zhengqiong ChenEmail author
Images in Obstetrics and Gynecology



The clinical outcomes are significantly different in accreta, increta, and percreta. There is currently no scoring system that can preoperatively distinguish its severity in an at-risk population. The aim of this study is to establish a scoring system for the prediction of the severity of placenta accrete spectrum (PAS) in women with placenta previa.


A prospective observational study was conducted in patients with placenta previa who delivered at a Chinese tertiary care center between June 12, 2016 and June 30, 2018. Optimal scaling regression was performed to determine the parameters which really contribute to the prediction of PAS, and calculate percentage of contribution.


Among 392 cases with placenta previa, 79, 53, and 28 had been surgically and/or histologically confirmed as accreta, increta, or percreta, respectively. Seven parameters were scheduled for the estimated scores for PAS, and five of them were finally entered into the predictive model. Their percentage of contribution was as follows: placental lacunas (19%), vascularity at the uterus–bladder interface (17.5%), myometrial thickness and hypoechoic retroplacental zone (25.6%), bladder line (22.6%), and previous caesarean sections (15.3%). The thresholds of scores for the prediction of accreta, increta, and percreta yielded 2.25–6.2, 6.2–8.95, and ≧ 8.95, respectively, with the positive and negative predictive value, and false positive rates of the scoring system were 96.68%, 95.44%, and 3.32%, respectively.


The scoring system can predict the severity of PAS in women with placenta previa. This will help identify the actual high-risk patients and improve their treatment.


Scoring system Placenta accrete spectrum Placenta previa Accreta Increta Percreta 



We thank LetPub ( for its linguistic assistance during the preparation of this manuscript.

Author contributions

ZQC: project development and manuscript editing. LL and QLS: data collection and manuscript writing. DMY, XHW, PY, and YY: data analysis.


This research was funded by Grants from the Science and Hygiene Joint Medical Research Project of Chongqing (no. 2018ZDXM034) and the Clinical Research Foundation of the Second Clinical Medical College of Army Medical University (no. 2016YLC28).

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest.

Ethical approval

This study was reviewed prior to data collection and approved by the Institutional Review Board at Xinqiao Hospital of Third Military Medical University, no. 20160228-1, dated 12 June 2016; and was registered with the Chinese Clinical Trials Registry, URL:, number ChiCTR-OOC-16008372. All patients signed informed consent upon admission to obtain their blood or tissue specimens and hospital data for analysis and publication. (The Second Clinical Medical College of Army Medical University was renamed from the Xinqiao Hospital of Third Military Medical University in 2018.)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecologythe Second Clinical Medical College of Army Medical UniversityChongqingPeople’s Republic of China

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