Placenta Accreta Spectrum Prenatal Diagnosis Performance: Are Ultrasound False-positive Results Acceptable in Limited-resources Settings?

Abstract

Objective The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital. Methods A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological). Results A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency. Conclusion The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.

Placenta Accreta Spectrum Disorder: A Retrospective Study of 78 Cases

“…A trial to separate the placenta was performed in most cases in this study, even those who had antenatal diagnosis, as Nieto-Calvache et al's study [22] advised to confirm the antenatal diagnosis intra-operatively because of common false-positive ultrasound results. Successful uterine preservation after placental separation and good hemostasis were performed in 33.33% of the PAS cases in this study for those cases with high concern for preserving fertility, which is somewhat similar to the 30% reported in Bailit et al's study [19].…”

Modified one-step conservative surgery for placenta accreta spectrum versus caesarean hysterectomy: The CMNT PAS prospective comparative Non-Randomized pilot study

“…Based on imaging studies, false positives are around 30%, which is why it's essential to verify before surgical procedures [9], so our criteria of confirmation per-operative were: Impossibility of manual removal of the placenta, without forcing.…”

Placental Area in the Lower Uterine Segment, Cervical Length, and Clinical Outcome in Pregnancies With Complete Placenta Previa

“…The blood loss of more than 2000 mL during cesarean section was defined as MIH. Placenta accreta spectrum (PAS) was diagnosed by clinical criteria for patients treated by conservative management and by histological examination for patients with hysterectomy according to FIGO criteria 16–18 . The following clinical data were recorded: the mean operation time, intraoperative blood loss, intraoperative blood transfusing, women required uterine artery embolization (UAE), hysterectomy, the mean neonatal birth weight, the incidence of preterm delivery, respiratory distress syndrome (RDS), admission to neonatal intensive care unit (NICU).…”