Objectives To elucidate the risk factor, histopathological correlations and diagnostic accuracy of prenatal imaging in detecting posterior PAS. Methods MEDLINE, Embase and CINAHL were searched. Inclusion criteria were women with posterior PAS confirmed either at surgery or histopathological analysis. The outcomes explored were: risk factor for posterior PAS, histopathological correlation, and diagnostic accuracy of ultrasound and MRI in detecting these anomalies. Random‐effect meta‐analyses of proportions and summary estimates of sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR–) and diagnostic odds ratio (DOR) using the hierarchical summary receiver–operating characteristics (HSROC) model were used to analyse the data. Results 20 studies were included. Placenta previa was present in 92.8% pregnancies complicated by posterior PAS, while 76.1% of women had a prior uterine surgery (11 studies, 53/ 88 women), mainly a CS or curettage. When considering the histopathological analysis of women affected by posterior PAS, 77.5% had placenta accrete (11 studies, 34/44 women) , 19.5% placenta increta (11 studies, 8/44 women) and 9.3% placenta percreta (11 studies, 2/44 women ). 56.4% of posterior PAS disorders were detected prenatally on ultrasound, while 46.7% were diagnosed only at birth (12 studies, 31 /63 women). When exploring the distribution of the classic ultrasound signs of PAS, placental lacunae were present in 39.0% (7 studies, 12/30 women), loss of the clear zone in 41.15% (7 studies, 13/30 women) and bladder wall interruption in 16.6% of women (7 studies, 4/30 women), while none of the included cases showed hypervascularization at the bladder wall interface. When assessing the role of MRI in detecting posterior PAS, 73.5% of cases were detected at prenatal MRI, while 26.5% were discovered only at the time of CS (11 studies, 26/32 women). Conclusion Placenta previa and prior uterine surgery represent the most commonly reported risk factors for posterior PAS. Ultrasound had a very low diagnostic accuracy in detecting these disorders prenatally.
Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: systematic review and meta-analysis / Tinari, S; Buca, D; Cali, G; Timor-Tritsch, I; Palacios-Jaraquemada, J; Rizzo, G; Lucidi, A; Di Mascio, D; Liberati, M; D'Antonio, F. - In: ULTRASOUND IN OBSTETRICS & GYNECOLOGY. - ISSN 0960-7692. - (2020). [10.1002/uog.22183]
Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: systematic review and meta-analysis
Di Mascio, D;
2020
Abstract
Objectives To elucidate the risk factor, histopathological correlations and diagnostic accuracy of prenatal imaging in detecting posterior PAS. Methods MEDLINE, Embase and CINAHL were searched. Inclusion criteria were women with posterior PAS confirmed either at surgery or histopathological analysis. The outcomes explored were: risk factor for posterior PAS, histopathological correlation, and diagnostic accuracy of ultrasound and MRI in detecting these anomalies. Random‐effect meta‐analyses of proportions and summary estimates of sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR–) and diagnostic odds ratio (DOR) using the hierarchical summary receiver–operating characteristics (HSROC) model were used to analyse the data. Results 20 studies were included. Placenta previa was present in 92.8% pregnancies complicated by posterior PAS, while 76.1% of women had a prior uterine surgery (11 studies, 53/ 88 women), mainly a CS or curettage. When considering the histopathological analysis of women affected by posterior PAS, 77.5% had placenta accrete (11 studies, 34/44 women) , 19.5% placenta increta (11 studies, 8/44 women) and 9.3% placenta percreta (11 studies, 2/44 women ). 56.4% of posterior PAS disorders were detected prenatally on ultrasound, while 46.7% were diagnosed only at birth (12 studies, 31 /63 women). When exploring the distribution of the classic ultrasound signs of PAS, placental lacunae were present in 39.0% (7 studies, 12/30 women), loss of the clear zone in 41.15% (7 studies, 13/30 women) and bladder wall interruption in 16.6% of women (7 studies, 4/30 women), while none of the included cases showed hypervascularization at the bladder wall interface. When assessing the role of MRI in detecting posterior PAS, 73.5% of cases were detected at prenatal MRI, while 26.5% were discovered only at the time of CS (11 studies, 26/32 women). Conclusion Placenta previa and prior uterine surgery represent the most commonly reported risk factors for posterior PAS. Ultrasound had a very low diagnostic accuracy in detecting these disorders prenatally.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
