Prenatal planning of placenta previa: diagnostic accuracy of a novel MRI-based prediction model for placenta accreta spectrum (PAS) and clinical outcome

Pizzi, Andrea Delli; Tavoletta, Alessandra; Narciso, Roberta; Mastrodicasa, Domenico; Trebeschi, Stefano; Celentano, Claudio; Mastracchio, Jacopo; Cianci, Roberta; Seccia, Barbara; Marrone, Luisa; Liberati, Marco; Cotroneo, Antonio Raffaele; Caulo, Massimo; Basilico, Raffaella

doi:10.1007/s00261-018-1882-8

Cited by 47 publications

(44 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Safe delivery in pregnancies complicated by AIP depends on the timely referral of a pregnant woman to a center specialized in treating placental pathologies, especially in the case of placenta percreta (AIP degree of invasion 3A to 3C according to FIGO classification) [3]. Ultrasound as the gold standard for diagnosing AIP in specialized hands yields a sensitivity and specificity of over 90% [4][5][6][7]. However, recent population studies from the UK, the USA, and northern Europe have shown that AIP remains undiagnosed before delivery in between half to two thirds of cases [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Maternal Serum VEGF Predicts Abnormally Invasive Placenta Better than NT-proBNP: a Multicenter Case-Control Study

et al. 2020

View full text Add to dashboard Cite

The aim of this study was to test if maternal serum vascular endothelial growth factor (VEGF) or N-terminal pro B-type natriuretic peptide (NT-proBNP) predicts abnormally invasive placenta (AIP) better. Secondary objective was to test whether the serum levels of VEGF and NT-proBNP can predict the degree of invasion. In a multicenter case–control study design, gestational age-matched serum samples from pregnant women with AIP (n = 44) and uncomplicated pregnancies (n = 55) who had been enrolled at Charité – Universitätsmedizin Berlin, Germany and Centre Hospitalier Régional de la Citadelle in Liège, Belgium were analyzed. Maternal blood serum VEGF and NT-proBNP levels were immunoassayed from samples taken immediately before delivery (GA median: 35 weeks). Biomarker levels were compared between AIP and control group. The correlation of biomarker levels with the clinical AIP degree was assessed. The predictive biomarker ability was characterized through a multivariate regression model and receiver operating characteristic curves. Women with AIP had significantly lower maternal serum VEGF levels (AIP mean 285 pg/ml, 95% CI 248–322, vs. control: 391 pg/ml, 95% CI 356–426, p < 0.01) and higher NT-proBNP levels (AIP median 329 pg/ml, IQR 287–385, vs. control 295 pg/ml, IQR 273–356, p = 0.03). Maternal serum VEGF levels were able to predict AIP better (AUC = 0.729, 0.622–0.836, p < 0.001; VEGF + number of previous cesarean deliveries: AUC = 0.915, 0.853–0.977, p < 0.001). Maternal serum VEGF levels correlated inversely with the clinical AIP degree (r = − 0.32, p < 0.01). In short, maternal serum VEGF, more than NT-proBNP, can help in predicting AIP and hints at the degree of invasion.

show abstract

Section: Introductionmentioning

confidence: 99%

Maternal Serum VEGF Predicts Abnormally Invasive Placenta Better than NT-proBNP: a Multicenter Case-Control Study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…However, for the prediction of posterior placenta previa with PAS, cervical varicosities were needed. Although previous reports did not predict placenta previa with PAS by separating the placental location, [11][12][13][14][15][16] our study The main limitations of this study were the single institutional retrospective nature of the study and the small sample size TA B L E 4 Sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds for the prediction of posterior placenta previa with placenta accreta spectrum using 4 MRI findings and cervical varicocities finding in 164 patients according to FIGO surgical classification Abbreviations: CI, confidence interval; MRI, magnetic resonance imaging.…”

Section: Discussionmentioning

confidence: 63%

“…[7][8][9][10] Studies on the prediction of placenta previa with PAS using magnetic resonance imaging (MRI) were conducted recently. [11][12][13][14] These studies mainly reported four MRI findings that were useful for the prediction of placenta previa with PAS with high sensitivity and specificity: dark T2weighted intraplacental bands, heterogeneous signals in the placenta, myometrial thinning or interruption, and focal uterine bulging. 14 However, other studies reported that it was difficult to predict the posterior placenta previa with PAS using these findings.…”

Section: Introductionmentioning

confidence: 99%

“…15,16 This may be because previous studies did not evaluate placenta previa with PAS separately for the anterior and posterior walls. [11][12][13][14][15][16] Thus, the differences in diagnostic accuracy predicted by these MRI findings between anterior and posterior placenta previa with PAS should be examined. Moreover, more accurate MRI findings to predict posterior placenta previa with PAS are needed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The use of magnetic resonance imaging to predict placenta previa with placenta accreta spectrum

Ishibashi

Miyamoto

Shinmoto

et al. 2020

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction: Massive hemorrhage due to placenta previa with placenta accreta spectrum is associated with high maternal mortality and morbidity. Therefore, accurate prediction of placenta previa with placenta accreta spectrum is essential; magnetic resonance imaging (MRI) is a useful tool for this purpose. This study investigated novel predictors of anterior and posterior placenta previa with placenta accreta spectrum using MRI. Material and methods: This was a retrospective study at a tertiary obstetrics hospital in Japan. The singleton patients with placenta previa who were scanned with MRI prenatally and had a cesarean section at our institution between 2007 and 2018 were included. The prediction of anterior and posterior placenta previa with placenta accreta spectrum was evaluated using four MRI findings: heterogeneous signals in the placenta, dark T2-weighted intraplacental bands, myometrial thinning or interruption, and focal uterine bulging. The prediction of posterior placenta previa with placenta accreta spectrum was performed using the quantification of cervical varicosities, which were defined as the ratio of the distance between the minimum distance from the most dorsal cervical varicosities (a) to the deciduous and amniotic placenta (b) on a sagittal image. Results: Among 202 patients, 14 (6.9%) patients were pathologically diagnosed as having placenta accreta spectrum. Further, 38 (18.8%) patients had anterior placenta previa and 164 (81.2%) patients had posterior placenta previa. When anterior placenta previa with placenta accreta spectrum was predicted using at least one of the four MRI findings, the sensitivity and specificity of the anterior placenta previa with placenta accreta spectrum were 87.5% and 86.7%, respectively. In contrast, the sensitivity and specificity of posterior placenta previa with placenta accreta spectrum were 42.9% and 96.2%, respectively. But when the A/B ratio was set at 0.20, the sensitivity and specificity of the prediction for posterior placenta previa with placenta accreta spectrum using cervical varicosities were 100.0% and 89.2%, respectively.

show abstract

“…Our study suggests that MRI was not more reliable or accurate in severe or difficult cases of PAS, although we did not specifically evaluate the ability of MRI to predict clinical outcomes. 23,24 In only one case of percreta did the radiologists agree on the presence of invasion. These data support the conclusion that the value of MRI in the diagnosis of PAS is undefined.…”

Section: Commentmentioning

confidence: 99%

Accuracy and Interobserver Reliability of Magnetic Resonance Imaging for Placenta Accreta Spectrum Disorders

et al. 2020

View full text Add to dashboard Cite

Objective This study aims to define the accuracy, predictive value, and interobserver reliability of magnetic resonance imaging (MRI) in the diagnosis of placenta accreta spectrum (PAS) disorders. Study Design Two experienced radiologists independently interpreted the MRI studies of patients with possible PAS from two referral centers. Radiologists were blinded to sonographic and clinical information. We calculated diagnostic testing characteristics and kappa statistics of interobserver reliability for MRI findings of PAS. Results Sixty-eight MRI cases were evaluated. Confirmed PAS and severe PAS were present in 44 (65%) and 20 (29%) cases. For the diagnosis of any PAS, MRI had a sensitivity 66%, specificity 71%, positive predictive value (PPV) 81%, negative predictive value (NPV) 53%, and accuracy 68%. For the diagnosis of severe PAS (percreta), MRI had a sensitivity 85%, specificity 79%, PPV 63%, NPV 93%, and accuracy 81%. The accuracy of individual signs of PAS was lower (44–65%). Interobserver agreement was almost perfect for previa; substantial for myometrial interruptions, PAS, severe PAS, and placental bulging/balling; and moderate to slight for other signs of PAS. Conclusion Although the interobserver reliability of MRI for a diagnosis of PAS is substantial, the accuracy and predictive value are modest and lower than previously reported.

show abstract

Prenatal planning of placenta previa: diagnostic accuracy of a novel MRI-based prediction model for placenta accreta spectrum (PAS) and clinical outcome

Cited by 47 publications

References 30 publications

Maternal Serum VEGF Predicts Abnormally Invasive Placenta Better than NT-proBNP: a Multicenter Case-Control Study

Maternal Serum VEGF Predicts Abnormally Invasive Placenta Better than NT-proBNP: a Multicenter Case-Control Study

The use of magnetic resonance imaging to predict placenta previa with placenta accreta spectrum

Accuracy and Interobserver Reliability of Magnetic Resonance Imaging for Placenta Accreta Spectrum Disorders

Contact Info

Product

Resources

About