Rethinking Prenatal Screening for Anomalies of Placental and Umbilical Cord Implantation

Jauniaux, Eric; Silver, Robert M.

doi:10.1097/aog.0000000000004175

Cited by 27 publications

(30 citation statements)

References 45 publications

(66 reference statements)

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“…The combination of placenta previa and accreta placentation leads to high maternal morbidity and sometimes mortality due to massive obstetric hemorrhage at delivery, particularly if the surgeon is unaware of the presence of PAS 11 . This group of patients should be the primary target of national screening programs 13 . However, the use of terminology and clinical description referring to neoplastic disorders 14,15 , such as 'placental invasion' or 'retroplacental neovascularization', combined with the use of the basic criteria proposed by Irving and Hertig to confirm the diagnosis of all grades of accreta placentation, has become increasingly confusing and is potentially delaying progress in the diagnosis and management of PAS.…”

Section: Introductionmentioning

confidence: 99%

Debunking 20^th century myths and legends about the diagnosis of placenta accreta spectrum

Jauniaux

Hussein

Einerson

et al. 2022

Ultrasound in Obstet & Gyne

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Section: Introductionmentioning

confidence: 99%

Debunking 20^th century myths and legends about the diagnosis of placenta accreta spectrum

Jauniaux

Hussein

Einerson

et al. 2022

Ultrasound in Obstet & Gyne

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“…The selection of subjects may be biased, and thus placenta accreta and the presentation of placenta praevia are highly correlated. According to related findings [ 18 , 19 ], nowadays, with the opening of China's fertility policy, the social pressure on women increases, resulting in higher childbearing age of women, and many studies have shown that the incidence of placenta accreta will increase with maternal age. Although the proportion of patients aged >35 years in the accreta group was higher than that in the non-accreta group in this study, the difference was not significant, which may be due to the small sample size, so an in-depth study with an expanded sample size should be carried out.…”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of the Prenatal Ultrasound Score of the Placenta Combined with Magnetic Resonance Imaging in Diagnosis of Placenta Accreta during the Second and Third Trimester of Pregnancy

Zhang

Dong²

2022

Contrast Media & Molecular Imaging

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Objective. The aim is to explore the clinical utility of the prenatal ultrasound score of the placenta combined with magnetic resonance imaging (MRI) in diagnosis of placenta accreta during the second and third trimester of pregnancy. Materials and Methods. A total of 108 pregnant women with suspected placenta accreta treated in Wuhan Hankou Hospital and Yantaishan Hospital of Yantai from January 2019 to January 2022 were retrospectively analyzed, the enrolled pregnant women received MRI examination because of suspected results of ultrasonic diagnosis, and by taking pathologic findings as the gold standard, the diagnostic efficacy of the ultrasound score, MRI, and their combination to placenta accreta during the second and third trimester of pregnancy was analyzed, and the diagnostic sensitivity, specificity, the positive predictive value, and the negative predictive value of these diagnostic modalities were evaluated. Results. Among 108 patients with suspected placenta accreta, 75 with pathologically confirmed placenta accreta were included in the accreta group, and 33 without placenta accreta were included in the non-accreta group; no statistical between-group differences in the patients’ age, gestational weeks, educational degree, and other general data were observed ( P > 0.05 ), but the history of cesarean section, history of induced abortion, and incidence rate of placenta praevia were significantly higher in the accreta group than in the non-accreta group ( P < 0.05 ); the ultrasound score was significantly higher in the accreta group than in the non-accreta group ( P < 0.05 ); the incidence rates of signs of “placental heterogeneity” and “bulge of lower segment of the uterus and local thickening of the placenta” were obviously higher in the accreta group than in the non-accreta group ( P < 0.05 ); according to the comparison with pathologic findings, the accuracy rate, sensitivity, specificity, the positive predictive value, and the negative predictive value of combined diagnosis were significantly higher than those of single application of the ultrasound score and MRI diagnosis ( P < 0.05 ); and ROC analysis found that the area under the curve of combined diagnosis was obviously larger than that of the ultrasound score and MRI diagnosis ( P < 0.05 ). Conclusion. A combining prenatal ultrasound score of the placenta with MRI plays an important role in the diagnosis of placenta accreta during the second and third trimester of pregnancy, which can further improve the diagnostic accuracy rate of placenta accreta and provide significant guidance in preventing high-risk complications during the perinatal period.

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“…All pregnancies managed by this center had gone through standardized complete placental evaluation. As suggested by the published guidelines ( 19 , 20 ), pregnancies with a prior history of cesarean section and/or uterine surgery, low-lying placenta and placenta previa based on ultrasound findings would be screened more rigorously for PAS. The specific ultrasonic signs for PAS were adherent to previously reported guidelines ( 21 , 22 ).…”

Section: Methodsmentioning

confidence: 99%

Placenta Accreta Spectrum Among Multiple Gestation: A Retrospective Analysis Based on a Chinese Population

et al. 2022

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BackgroundIt remained controversial whether women with multiple gestation are at higher risk of placenta accreta spectrum (PAS) disorders and large-scale studies are needed. This study aimed to assess whether PAS incidence is higher among women with multiple gestation than among singleton, as well as to compare the characteristics and outcomes of PAS in multiple and singleton gestation.MethodsWomen who underwent cesarean section with live births at Peking University First Hospital from January 2015 to December 2020 were included. Demographic and clinical information was collected through chart review. Logistic regression models were used to analyze the associations between multiple gestation and PAS. The clinical characteristics and perioperative outcomes of PAS in multiple and singleton gestation were further compared.ResultsAmong the 14583 women included, 2.4% (352/14583) were diagnosed with PAS. PAS was slightly more prevalent among multiple gestations than among singletons (2.5% vs 2.4%, P=0.857). After adjusting for known risk factors and pregnancy complications, multiple gestation was associated with a higher risk of PAS (aOR=1.63, 95% CI 1.01-2.62). Among PAS patients, women who had multiple births had a significantly lower rate of previous cesarean deliveries (27.6% vs. 56.3%, P=0.003), placenta previa (17.2% vs. 56.3%, P<0.001) and invasive PAS (24.1% vs. 53.9, P=0.002) than singletons. There were no significant differences in perioperative outcomes between these two groups.ConclusionMultiple gestation could be independently associated with an elevated risk of PAS. The clinical characteristics of PAS in the multiple and singleton gestation groups differed significantly in cesarean delivery history and placenta previa. The results of this study may inform guidelines on the screening, early detection and timely intervention of PAS patients among women with multiple births.

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Rethinking Prenatal Screening for Anomalies of Placental and Umbilical Cord Implantation

Abstract: The views expressed in this document reflect the opinion of the individuals and not necessarily those of the institutions that they represent.

Cited by 27 publications

References 45 publications

Debunking 20^th century myths and legends about the diagnosis of placenta accreta spectrum

Debunking 20^th century myths and legends about the diagnosis of placenta accreta spectrum

Clinical Utility of the Prenatal Ultrasound Score of the Placenta Combined with Magnetic Resonance Imaging in Diagnosis of Placenta Accreta during the Second and Third Trimester of Pregnancy

Placenta Accreta Spectrum Among Multiple Gestation: A Retrospective Analysis Based on a Chinese Population

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Rethinking Prenatal Screening for Anomalies of Placental and Umbilical Cord Implantation

Abstract: The views expressed in this document reflect the opinion of the individuals and not necessarily those of the institutions that they represent.

Cited by 27 publications

References 45 publications

Debunking 20th century myths and legends about the diagnosis of placenta accreta spectrum

Debunking 20th century myths and legends about the diagnosis of placenta accreta spectrum

Clinical Utility of the Prenatal Ultrasound Score of the Placenta Combined with Magnetic Resonance Imaging in Diagnosis of Placenta Accreta during the Second and Third Trimester of Pregnancy

Placenta Accreta Spectrum Among Multiple Gestation: A Retrospective Analysis Based on a Chinese Population

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Debunking 20^th century myths and legends about the diagnosis of placenta accreta spectrum

Debunking 20^th century myths and legends about the diagnosis of placenta accreta spectrum