Relationship between the Prenatal Diagnosis of Placenta Acreta Spectrum and Lower Use of Blood Components

Abstract

Objective To describe the clinical results of patients admitted and managed as cases of placenta accreta spectrum (PAS) at a Central American public hospital and the influence of the prenatal diagnosis on the condition. Materials and Methods A retrospective analysis of PAS patients treated at Hospital Bertha Calderón Roque, in Managua, Nicaragua, between June 2017 and September 2021. The diagnostic criteria used were those of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French). The population was divided into patients with a prenatal ultrasonographic diagnosis of PAS (group 1) and those whose the diagnosis of PAS was established at the time of the caesarean section (group 2). Results: During the search, we found 103 cases with a histological and/or clinical diagnosis of PAS; groups 1 and 2 were composed of 51 and 52 patients respectively. Regarding the clinical results of both groups, the patients in group 1 presented a lower frequency of transfusions (56.9% versus 96.1% in group 2), use of a lower number of red blood cell units (RBCUs) among those undergoing transfusions (median: 1; interquartile range: [IQR]: 0–4 versus median: 3; [IQR]: 2–4] in group 2), and lower frequency of 4 or more RBCU transfusions (29.4% versus 46.1% in group 2). Group 1 also exhibited a non-significant trend toward a lower volume of blood loss (1,000 mL [IQR]: 750–2,000 mL versus 1,500 mL [IQR]: 1,200–1,800 mL in group 2), and lower requirement of pelvic packing (1.9% versus 7.7% in group 2). Conclusion Establishing a prenatal diagnosis of PAS is related to a lower frequency of transfusions. We observed a high frequency of prenatal diagnostic failures of PAS. It is a priority to improve prenatal detection of this disease.

Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta‐analysis

“…The initial search resulted in 856 articles, of which 758 were excluded, as the reported outcomes were not relevant, leaving 98 studies that were obtained for full‐text review. An additional 36 articles were excluded after full review, leaving 62 articles for the systematic review 18–79 (Figure 1 and Tables 1 and S2). Of these, 56 studies were included in the meta‐analysis 18–24, 26–33,35–44,46–61,63–69,71–77,79 , while six studies were excluded from the pooled analysis due to potential overlap in populations.…”

“…An additional 36 articles were excluded after full review, leaving 62 articles for the systematic review 18–79 (Figure 1 and Tables 1 and S2). Of these, 56 studies were included in the meta‐analysis 18–24, 26–33,35–44,46–61,63–69,71–77,79 , while six studies were excluded from the pooled analysis due to potential overlap in populations. Some of the included studies were still at risk of overlap; in these cases, national studies were prioritized for inclusion, unless they did not report on the evaluated outcome.…”

“…When considering only studies with ≥ 12 cases per year, the incidence of urological complications was similar to that reported in the primary analysis (Table S3). 18 Erfani (2022) 29 Kuznetsova (2022) 19 Munoz (2022) 20 Overton (2022) 21 Pav ón-Gomez (2022) 22 Scaglione (2022) 23 Sentilhes (2022) 24 Smith (2022) 25 Taskeen (2022) 26 Uddén (2022) 34 Xin (2022) 27 Bakacak (2021) 28 Celik (2021) 40 Crocetto (2021) 41 Matsuzaki (2021) 30 Morlando (2021) 31 Nieto-Calvache (2021) 43 Parveen (2021) 32 Soleymani Majd (2021) 33 van Beekhuizen (2021) 35 Chahal (2020) 36 Dall'Asta (2020) 37 Nisar (2020) 38 Zuckerwise (2020) 45 Alanwar (2019) 52 Dawood (2019) 42 Meller (2019) 47 Sak (2019) 44 Shmakov (2019) 49 Marcellin (2018) 46 Özcan (2018) 48 Pala (2018) 54 Saha (2018) 39 Thabet (2018) 50 Zhao (2018) 51 Chaudhari (2017) 55 Karaman (2017) 56 Lee (2017) 53 Camuzcuoglu (2016) 57 Norris (2016) 59 Thurn (2016) 61 Shabana (2015) 60 Shams...…”

Diagnostic Role of Cell-Free miRNAs in Identifying Placenta Accreta Spectrum during First-Trimester Screening

“…The main complications of PAS include massive blood loss, disseminated intravascular coagulation, hysterectomy, and preterm birth, leading to increased maternal and fetal morbidity and mortality [15]. Despite improvements in ultrasound protocols [1,16,17], the frequency of undiagnosed PAS before delivery is variable [18,19], partly due to the different ultrasound equipment used by ultrasound examinators, the subjective quality of the ultrasound sings of PAS, and the lack of clear evaluation criteria for each of the three grades of PAS. Therefore, the timely and accurate antenatal diagnosis of PAS is essential to formulate the correct patient management algorithm and plan delivery by a multidisciplinary team to reduce the frequency of postpartum complications as also claimed by Pavón-Gomez N. et al [19].…”

“…Despite improvements in ultrasound protocols [1,16,17], the frequency of undiagnosed PAS before delivery is variable [18,19], partly due to the different ultrasound equipment used by ultrasound examinators, the subjective quality of the ultrasound sings of PAS, and the lack of clear evaluation criteria for each of the three grades of PAS. Therefore, the timely and accurate antenatal diagnosis of PAS is essential to formulate the correct patient management algorithm and plan delivery by a multidisciplinary team to reduce the frequency of postpartum complications as also claimed by Pavón-Gomez N. et al [19]. Therefore, there is a high need for an additional non-invasive test to differentiate real PAS from ultrasound suspected ones antenatally, preferably in the first trimester of pregnancy.…”