Creatine Kinase as a Potential Diagnostic Biomarker for Distinguishing Placenta Accreta Spectrum and Placenta Previa: A Prospective Pilot Study

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2026-09-06 DOI:10.1111/jog.70472

Lulu Wang, Tianjiao Liu, Liwen Yang, Xinyu Xiao, Jiaxin Chen, Limin Wang

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引用次数: 0

Abstract

Background

Placenta previa (PP) and placenta accreta spectrum (PAS) are major causes of severe obstetric hemorrhage, yet in some scenarios, antenatal discrimination and risk stratification remain challenging with imaging alone. An inexpensive, widely available adjunct biomarker such as maternal serum creatine kinase (CK) may help differentiate PP from PAS, reflect imaging-based placental severity, and identify women at increased risk of intraoperative massive hemorrhage.

Methods

This pilot prospective cohort study enrolled women with singleton pregnancies managed at a tertiary center between January 2025 and January 2026 with suspected PP or PAS. PP and PAS were confirmed by intraoperative inspection and postoperative histopathology. Serum CK was measured using third-trimester blood samples. Ultrasound and MRI placental scores were calculated using predefined scoring systems. Spearman correlation assessed associations between CK and imaging scores. Multivariable logistic regression explored risk factors for intraoperative massive hemorrhage.

Results

Thirty-one participants were included (PP, n = 22; PAS, n = 9). Late-gestation CK levels were significantly higher in PAS than PP (78.28 ± 30.01 vs. 38.07 ± 17.86 U/L; p = 0.041). PAS had higher ultrasound and MRI placental scores than PP (both p < 0.001). CK was moderately positively correlated with the ultrasound score (ρ = 0.484, p = 0.003) and MRI score (ρ = 0.401, p = 0.026). In multivariable analyses, higher CK, more prior cesarean deliveries, and higher ultrasound and MRI scores were associated with increased odds of intraoperative massive hemorrhage.

Conclusion

Late-gestation maternal serum CK was elevated in PAS versus PP, correlated with ultrasound- and MRI-based placental scores, and was associated with massive hemorrhage risk, suggesting CK as a potential adjunct biomarker for PAS.

Trial registration: ChiCTR2100054068, December 8, 2021.

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肌酸激酶作为区分前置胎盘和增生胎盘的潜在诊断生物标志物：一项前瞻性先导研究。

背景：前置胎盘（PP）和胎盘增生谱（PAS）是严重产科出血的主要原因，但在某些情况下，仅凭影像学检查，产前歧视和风险分层仍然具有挑战性。一种廉价、广泛可用的辅助生物标志物，如母体血清肌酸激酶（CK），可能有助于区分PP和PAS，反映基于成像的胎盘严重程度，并识别术中大出血风险增加的妇女。方法：本前瞻性队列研究纳入了2025年1月至2026年1月间在一家三级医疗中心就诊的怀疑患有PP或PAS的单胎妊娠妇女。术中检查和术后组织病理证实PP和PAS。采用妊娠晚期血样测定血清CK。使用预定义的评分系统计算超声和MRI胎盘评分。Spearman相关性评估CK和影像学评分之间的关联。多变量logistic回归分析术中大出血的危险因素。结果：共纳入31例受试者（PP, n = 22； PAS, n = 9）。妊娠后期，PAS组CK水平显著高于PP组（78.28±30.01∶38.07±17.86 U/L; p = 0.041）。PAS的超声和MRI胎盘评分高于PP（均为p）。结论：与PP相比，PAS妊娠后期产妇血清CK升高，与超声和MRI胎盘评分相关，并与大出血风险相关，提示CK可能是PAS的辅助生物标志物。试验注册：ChiCTR2100054068, 2021年12月8日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.