Clinical and Ultrasound Predictors of Placenta Accreta in Pregnant Women with Antepartum Diagnosis of Placenta Previa: A Multicenter Study

Vita, Davide De; Capobianco, Giampiero; Gerosolima, Giovanni; Sciorio, C.; Coppola, Ermenegilda; Parazzini, Fabio; Silvestri, Maurizio; Caruso, Anna Paola; Morlando, Maddalena; Petta, Raffaele; Pascarella, A; Dessole, Salvatore; Viora, E.

doi:10.1159/000494492

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…Our search strategy identified 1235 unique studies for screening. A total of 37 studies, including 5764 pregnancies at high risk of PAS, met our inclusion criteria and were therefore included in the analysis 14–50 (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen studies had at least one domain at high risk of bias. Seven studies had high risk of bias for patient selection [14][15][16][17][18][19][20] , three studies had high risk in the reference-standard domain [21][22][23] , four studies were high risk for flow and timing of the study [24][25][26][27] and one study had high risk for the index test 30 .…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Trimester‐specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta‐analysis

Hessami,

Horgan,

Munoz

et al. 2024

Ultrasound in Obstet & Gyne

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BackgroundThis study aimed to assess the diagnostic accuracy of ultrasound for detecting placenta accreta spectrum (PAS) during the first trimester of pregnancy and compare it with the accuracy of second and third trimester ultrasound in pregnancies at risk for PAS.MethodsPubMed, Embase, and Web of Science, databases were searched to identify relevant studies published from inception until March 10th, 2023. Inclusion criteria were all studies, including cohort, case‐control, or cross‐sectional studies, that evaluated the diagnostic accuracy of first trimester ultrasound performed prior to 14 weeks (first trimester) or after 14 weeks of gestation (second/third trimester) for diagnosis of PAS in pregnancies with clinical risk factors. The primary outcome was to assess the diagnostic accuracy of ultrasound in detecting PAS in the first trimester, and to compare it with the accuracy of ultrasound in the second and third trimesters. The secondary outcome was to evaluate the diagnostic accuracy of each ultrasonographic marker individually across the trimesters of pregnancy. Reference standard was PAS confirmed at pathological or surgical examination. The potential of ultrasound and different ultrasound signs to detect PAS was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and positive (LR+) and negative (LR‐) likelihood ratios.ResultsA total of 37 studies including 5,764 pregnancies at risk of PAS, with 1,348 cases of confirmed PAS, were included in our analysis. The meta‐analysis yielded a sensitivity of 86% (95% CI: 78%, 92%) and specificity of 63% (95% CI: 55%, 70%) during the 1st trimester, while the sensitivity was 88% (95% CI: 84%, 91%) and specificity was 92% (95% CI: 85%, 96%) during the 2nd/3rd trimester. Regarding ultrasonographic markers examined in the 1st trimester, lower uterine hypervascularity exhibited the highest sensitivity of 97% (95% CI: 19%, 100%), and uterovesical interface irregularity demonstrated the highest specificity of 99% (95% CI: 96%, 100%). However, in the 2nd/3rd trimester, loss of clear zone had the highest sensitivity of 80% (95% CI: 72%, 86%), while uterovesical interface irregularity exhibited the highest specificity of 99% (95% CI: 97%, 100%).ConclusionFirst trimester ultrasound has similar accuracy to second and third trimester ultrasound for the diagnosis of PAS. Routine first trimester ultrasound screening for patients at high risk of PAS may improve detection rates and allow earlier referral to tertiary care centers for pregnancy management.This article is protected by copyright. All rights reserved.

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Section: Resultsmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Trimester‐specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta‐analysis

Hessami,

Horgan,

Munoz

et al. 2024

Ultrasound in Obstet & Gyne

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“…Other approaches to pelvic hemorrhage such as from placenta accreta [14] include correction of coagulopathies, internal iliac artery, and abdominal aorta balloon occlusions [15]; manual aortic pressure or aortic clamping, inferior mesenteric artery clamping; uterine and utero-ovarian vessel occlusion [16]; and bilateral internal ileac artery ligation.…”

Section: Discussionmentioning

confidence: 99%

Foley Catheter Tourniquet for Uncontrollable Extra-Uterine Placental Hemorrhage: Description of a Novel Surgical Technique

Hofmeyr

Majeke

Nassali

2021

Gynecol Obstet Invest

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Introduction Hemorrhage from a partially or fully detached placenta with an advanced abdominal pregnancy can be profuse and catastrophic. The general approach to placenta management is removal of “all or nothing’’. In the event of acute hemorrhage, every attempt to achieve hemostasis quickly is critical. The Foley catheter has shown utility when used to control placental hemorrhage or as a temporary tourniquet applied around structures surrounding the implantation site to aid placental removal with minimal hemorrhage. We report use of the technique on four occasions with good surgical outcomes. Case Presentation We report a case of a 33 year-old primigravida admitted at term with an ultrasound diagnosis of breech presentation and placenta previa grade four. Her pre-operative clinical assessment however, raised suspicion of an abdominal pregnancy. At laparotomy, a live female infant was delivered from the extra-uterine gestation sac, weighing 3640g and with an Apgar score of 7 and 6 at one and 5 minutes respectively. Following delivery, there was profuse bleeding from the partially detached distal portion of the placenta that derived rich blood supply from the poorly accessible posterior pelvic wall. We applied a novel, simple and effective surgical technique for minimizing blood loss from the partially detached placenta using a Foley’s catheter tourniquet that was applied between the detached and still attached parts of the placenta. The tourniquet was left in situ and removed at laparotomy 4 days later. The placenta was not removed. The mother and baby did well postoperatively and were discharged after 10 and 21 days respectively in good condition. The surgical technique was similarly used in 3 additional cases with good clinical outcomes. Discussion Use of a Foley catheter as an intraoperative tourniquet has become accepted as a useful technique in obstetric and gynecological surgery. We describe a simple life saving technique of applying a Foley tourniquet across a partially detached placenta following an advanced extra-uterine pregnancy to control acute hemorrhage. Conclusion We recommend that surgeons keep in mind the option of intraoperative tourniquets when faced with uncontrollable bleeding as a short-term or medium-term temporizing measure.

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“…Risk assessment of PAS has been frequently investigated, primarily to predict a confirmed diagnosis based on antepartum clinical and sonographic criteria 10 . However, risk stratification of women who would be eventually diagnosed with PAS has not been systematically addressed.…”

Section: Discussionmentioning

confidence: 99%

Placenta accreta risk—antepartum score in predicting clinical outcomes of placenta accreta spectrum: A multicenter validation study

Shazly

Anan

Makukhina

et al. 2021

Intl J Gynecology & Obste

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Objective: To validate the use of placenta accreta risk-antepartum (PAR-A) score as a predictive tool of clinical outcomes of placenta accreta spectrum (PAS).Methods: This is a prospective study, conducted in six PAS specialized centers in six different countries. The study was conducted between October 1, 2020 and March 31, 2021. Women who were provisionally diagnosed with PAS during pregnancy were considered eligible. A machine-learning-based PAR-A score was calculated. Diagnostic performance of the PAR-A score was evaluated using a receiver operating characteristic curve, for perioperative massive blood loss and admission to intensive care unit (ClinicalTrials.gov identifier NCT04525001).Results: Of 97 eligible women, 86 were included. PAS-associated massive blood loss occurred in 10 patients (11.63%). Median PAR-A scores of massive blood loss in the current cohort were 8.9 (interquartile range 6.9-14.1). In predicting massive blood loss, the area under the curve of PAR-A scores was 0.85 (95% confidence interval [CI] 0.74-0.95), which was not significantly different from the original cohort (P = 0.2). PAR-A score prediction of intensive care unit admission was slightly higher compared with the original cohort (0.88, 95% CI 0.81-0.95; P = 0.06). Conclusion:PAR-A score is a novel scoring system of PAS outcomes, which showed external validity based on current data.

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Clinical and Ultrasound Predictors of Placenta Accreta in Pregnant Women with Antepartum Diagnosis of Placenta Previa: A Multicenter Study

Cited by 10 publications

References 27 publications

Trimester‐specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta‐analysis

Trimester‐specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta‐analysis

Foley Catheter Tourniquet for Uncontrollable Extra-Uterine Placental Hemorrhage: Description of a Novel Surgical Technique

Placenta accreta risk—antepartum score in predicting clinical outcomes of placenta accreta spectrum: A multicenter validation study

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