SERUM VASCULAR CELL ADHESION MOLECULE-1 AND THE DEPTH OF PLACENTAL INVASION IN PLACENTA ACCRETA SPECTRUM DISORDER: A CASE-CONTROL STUDY

Abstrak

Background: Placenta accreta spectrum disorder (PASD) carries high maternal morbidity, yet no serum marker has entered clinical practice. Vascular cell adhesion molecule-1 (VCAM-1) mediates angiogenesis and trophoblast invasion, but whether its concentration tracks the depth of invasion is unknown. Methods: In a case-control study at Haji Adam Malik General Hospital and the network hospitals of Universitas Sumatera Utara, Medan (March–September 2024), 31 women with PASD confirmed by post-hysterectomy histopathology and 32 women with normal pregnancy were recruited consecutively. Serum VCAM-1 was measured at least seven days before delivery. Groups were compared by the Welch t-test and invasion subgroups by ANOVA with the Tukey post-hoc test, with multivariable logistic regression and receiver operating characteristic analysis. Results: VCAM-1 was higher in PASD than in normal pregnancy (435.35 ± 169.61 versus 293.12 ± 77.36 ng/mL; p<0.001) and rose across invasion depth — accreta 301.78 ± 72.16, increta 440.63 ± 196.09, percreta 518.21 ± 150.70 ng/mL (p=0.007) — with the post-hoc difference significant between accreta and percreta (p=0.005). After adjustment for maternal age and gestational age, VCAM-1 remained an independent predictor (adjusted odds ratio 2.97 per 100 ng/mL, 95% CI 1.52–5.80; p=0.001), and the area under the curve rose from 0.763 to 0.892. The Youden-optimal cut-off was 397 ng/mL (sensitivity 61.3%, specificity 93.8%). Conclusion: Serum VCAM-1 is independently associated with PASD and increases with the depth of placental invasion, supporting further evaluation as an adjunct to prenatal ultrasound rather than as a stand-alone test.