Potential Serum Biomarkers in Prenatal Diagnosis of Placenta Accreta Spectrum

Abstract

Placenta accreta spectrum (PAS) refers to the abnormal invasion of trophoblastic tissues. Because of its increasing morbidity and possibility of catastrophic outcomes, PAS requires an antenatal diagnosis and making full preparations in advance to realize safe delivery. Current clinical screening modalities for PAS are not always conclusive. Recently, it has been reported that bio-markers detected in maternal serum have the potential for predicting PAS during pregnancy. Some of these biomarkers, such as β-hcg, AFP, PAPP-A, and cffDNA, can be clinically detected. It is convenient for us to test and compare with standard threshold. However, how can we distinguishing PAS from other pregnancy complications through these biomarkers remains complicated. Some biomarkers are specific, such as microRNA and placenta-specific mRNA. They are stability and reliability. These biomarkers are currently research hotspots. This study aims to summarize the characteristics of the newly reported biomarkers and to point out their potential application and current limitations to provide a basis for future research. Finally, the combination of imageological examination and biomarkers will be an attractive future theme to study in diagnosing this challenging condition.

Placenta Accreta Spectrum Diagnosis Challenges and Controversies in Current Obstetrics: A Review

“…Although prenatal maternal serum AFP detection is convenient, according to some domestic scholars, the sensitivity and specificity of prenatal maternal serum AFP in the diagnosis of placenta previa complicated with PAS are only 71% and 46%, respectively. 46 This high detection rate might be accidental and can be explained by the fact that elevated serum level of AFP is also found in multiple pregnancies, fetal growth defects, neural tube diseases, ventral wall defects, fetal aneuploidies, fetal kidney defects, fetal demise, and so on. 52 , 53 In order to avoid false-positive results, the detection of maternal AFP in screening PAS must be combined with the detection of high-risk women to screen for PAS with serological tests, and then the use of higher resolution imaging tools like 3-dimensional ultrasound or MRI to exclude these fetal abnormalities.…”

“… Ancient study. Zhang et al 46 2022 N/A AFP N/A Review AFP could predict PAS in the second trimester and PAS cases needing hysterectomy. The association’s, reliability and accuracy between AFP and PAS were deficient.…”

“…Numerous features, such us fetal abnormalities, and other types of placental abnormalities influenced AFP levels. Zhang et al 46 2022 N/A β-hCG N/A Review All the four studies included in the review established the association between β-hCG and PAS. Serum β-hCG levels were also associated with some other disorders: miscarriage, ectopic pregnancy, and fetal abnormalities.…”

“… Serum β-hCG levels were also associated with some other disorders: miscarriage, ectopic pregnancy, and fetal abnormalities. Zhang et al 46 2022 N/A PAPP-A N/A Review PAPP-A could identify high-risk women for PAS. No limitations were reported for PAPP-A.…”

“… No limitations were reported for PAPP-A. Zhang et al 46 2022 N/A cffDNA N/A Review cffDNA could be a suitable bio-marker detected early in the first trimester. Serum cffDNA samples might be influenced by many factors: their concentrations, isolation method of DNA, gestation of the acquired sample, and length range of cffDNA.…”