The Role of YKL-40 in the Diagnosis of Placenta Accreta Spectrum in a Group of Iraqi Patients

Background: As the number of caesarean deliveries has escalated over the last 50 years, Placenta Accreta Spectrum is now emerging as a more frequent pregnancy- related issue. The incidence of this problem is increasing, with recent estimates indicating an approximate 1/333 to 1/533 deliveries. Recent studies reveal that YKL-40 (also known as Chitinase-3-like protein 1 which is a secreted glycoprotein that is approximately 40kDa in size) may be involved in angiogenesis, cell proliferation and differentiation as well as extracellular matrix remodeling, and other inflammatory processes. Objectives: To evaluate the association between maternal serum YKL-40 levels and the severity of Placenta Accreta Spectrum. Methods: A case - control study was conducted in the Department of Obstetrics and Gynecology at Baghdad Teaching Hospital, Baghdad, from June 1, 2023, to June 1, 2024. It included 97 pregnant women with singleton pregnancy in the third trimester, having a diagnosis of Placenta Accreta Spectrum (37 patients), and those with normally sited placenta admitted for delivery either by vaginal or caesarean section (60 controls). The serum YKL40 biomarker was investigated in both groups. Results: The mean level of the YKL-40 was significantly higher in patients diagnosed with placenta accreta spectrum than in those with a normal placenta. As the cut-off point for the YKL-40 is 112.68 pg/ml, a YKL-40 level > 112.68 pg/ml was associated with placenta accreta spectrum. Conclusion: Serum YKL-40 appears to be a promising biomarker associated with the presence and clinical severity of Placenta Accreta Spectrum in the third trimester. While its role as a primary diagnostic tool is limited by the availability of imaging techniques at this stage of pregnancy, it shows a significant correlation with the depth of placental invasion. y.