First‐trimester detection of abnormally invasive placenta in high‐risk women: systematic review and meta‐analysis

D’Antonio, Francesco; Timor‐Tritsch, Ilan E.; Palacios‐Jaraquemada, José Miguel; Monteagudo, Ana; Buca, D.; Forlani, F.; Minneci, G.; Foti, Francesca; Manzoli, Lamberto; Liberati, Marco; Acharya, Ganesh; Calì, Giuseppe

doi:10.1002/uog.18840

Cited by 84 publications

(68 citation statements)

References 43 publications

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“…Low implantation of the gestational sac was diagnosed when the lower placental edge or the gestational sac were within or in close proximity to the area of the cesarean scar; middle implantation was defined as the upper placental edge or gestational sac implanted away from its normal position in the fundal part of the uterus but not embedded or in close proximity to the previous cesarean scar. Ultrasonography assessment was performed via transvaginal ultrasonography in the early first trimester of pregnancy and by transabdominal ultrasonography at all the other time points, as described previously . All examinations were performed using 4.0–6.0 MHz curved transabdominal or 5.0–7.0 MHz endovaginal transducers; when performing color Doppler ultrasonography, the pulsed rate frequency was set lower at 1.3 kHz to identify the presence of placental lacunar flow.…”

Section: Methodsmentioning

confidence: 99%

Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy

Calì

Timor-Trisch

Palacios‐Jaraquemada

et al. 2018

Intl J Gynecology & Obste

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Section: Methodsmentioning

confidence: 99%

Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy

Calì

Timor-Trisch

Palacios‐Jaraquemada

et al. 2018

Intl J Gynecology & Obste

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“…Advances in prenatal imaging have led to an increase in the detection rate of PAS, which in turn has improved the surgical and maternal outcome. We recently described a prenatal ultrasound staging system for PAS disorders which is based on a number of ultrasound signs in women at high risk for these disorders.…”

Section: Introductionmentioning

confidence: 99%

Value of first‐trimester ultrasound in prediction of third‐trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome

Calì

Timor‐Tritsch

Forlani

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To explore whether early first‐trimester ultrasound can predict the third‐trimester sonographic stage of placenta accreta spectrum (PAS) disorder and to elucidate whether combining first‐trimester ultrasound findings with the sonographic stage of PAS disorder can stratify the risk of adverse surgical outcome in women at risk for PAS disorder. Methods This was a retrospective analysis of prospectively collected data from women with placenta previa, and at least one previous Cesarean delivery (CD) or uterine surgery, for whom early first‐trimester (5–7 weeks' gestation) ultrasound images could be retrieved. The relationship between the position of the gestational sac and the prior CD scar was assessed using three sonographic markers for first‐trimester assessment of Cesarean scar (CS) pregnancy, reported by Calí et al. (crossover sign (COS)), Kaelin Agten et al. (implantation of the gestational sac on the scar vs in the niche of the CS) and Timor‐Tritsch et al. (position of the center of the gestational sac below vs above the midline of the uterus), by two different examiners blinded to the final diagnosis and clinical outcome. The primary aim of the study was to explore the association between first‐trimester ultrasound findings and the stage of PAS disorder on third‐trimester ultrasound. Our secondary aim was to elucidate whether the combination of first‐trimester ultrasound findings and sonographic stage of PAS disorder can predict surgical outcome. Logistic regression analysis and area under the receiver‐operating‐characteristics curve (AUC) were used to analyze the data. Results One hundred and eighty‐seven women with vasa previa were included. In this cohort, 79.6% (95% CI, 67.1–88.2%) of women classified as COS‐1, 94.4% (95% CI, 84.9–98.1%) of those with gestational‐sac implantation in the niche of the prior CS and 100% (95% CI, 93.4–100%) of those with gestational sac located below the uterine midline, on first‐trimester ultrasound, were affected by the severest form of PAS disorder (PAS3) on third‐trimester ultrasound. On multivariate logistic regression analysis, COS‐1 (odds ratio (OR), 7.9 (95% CI, 4.0–15.5); P < 0.001), implantation of the gestational sac in the niche (OR, 29.1 (95% CI, 8.1–104); P < 0.001) and location of the gestational sac below the midline of the uterus (OR, 38.1 (95% CI, 12.0–121); P < 0.001) were associated independently with PAS3, whereas parity (P = 0.4) and the number of prior CDs (P = 0.5) were not. When translating these figures into diagnostic models, first‐trimester diagnosis of COS‐1 (AUC, 0.94 (95% CI, 0.91–0.97)), pregnancy implantation in the niche (AUC, 0.92 (95% CI, 0.89–0.96)) and gestational sac below the uterine midline (AUC, 0.92 (95% CI, 0.88–0.96)) had a high predictive accuracy for PAS3. There was an adverse surgical outcome in 22/187 pregnancies and it was more common in women with, compared to those without, COS‐1 (P < 0.001), gestational‐sac implantation in the niche (P < 0.001) and gestational‐sac position below the uterine midline (P <...

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“…Prenatal diagnosis of placenta previa in the first trimester is not completely reliable, as a significant proportion of placenta would move away from the cervix in the second and third trimester of pregnancy. In this scenario, the large majority of women with a diagnosis of placenta previa in the first trimester of pregnancy will not be affected by this condition later on in pregnancy potentially leading to unnecessary parental anxiety . Since the combination of a CS and placenta previa in a subsequent pregnancy represent high risk of PAS, we suggest that in this subset of women, the finding of placenta previa (incidental or not) should routinely be reported as one of its early warning signs (Figure ).…”

mentioning

confidence: 99%

Placenta accreta spectrum disorders: Prenatal diagnosis still lacks clinical correlation

D’Antonio

Palacios‐Jaraquemada

Timor-Trisch

et al. 2018

Acta Obstet Gynecol Scand

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First‐trimester detection of abnormally invasive placenta in high‐risk women: systematic review and meta‐analysis

Cited by 84 publications

References 43 publications

Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy

Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy

Value of first‐trimester ultrasound in prediction of third‐trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome

Placenta accreta spectrum disorders: Prenatal diagnosis still lacks clinical correlation

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