The clinical utility of magnetic resonance imaging as an adjunct to ultrasound in the diagnosis of placenta accreta spectrum disorders

Rekawek, Patricia; Liu, Lilly; Pan, Stephanie; Overbey, Jessica; Wagner, Brian

doi:10.1080/14767058.2021.1903861

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Accurate diagnosis of patients with placenta accreta can reduce the risk of hemorrhage during childbirth. Some studies have pointed out that misdiagnosis and missed diagnosis can occur when ultrasound and MRI diagnosis are used in isolation (19,20). Einerson et al (21) found that the misdiagnosis rate of placenta accreta using MRI was 23% and the missed diagnosis rate was approximately 14%; additionally, only two out of 14 patients with placenta accreta detected by ultrasound were confirmed using MRI.…”

Section: Discussionmentioning

confidence: 99%

Clinical diagnostic value and analysis of MRI combined with ultrasound in prenatal pernicious placenta previa with placenta accreta

Guo¹,

Wu²,

Yuan³

et al. 2021

Ann Palliat Med

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Background: Placenta previa is one dangerous disease which threatens the health of pregnant women and their fetuses. The purpose of this study was to evaluate the clinical value of ultrasound combined with magnetic resonance imaging (MRI) in screening for placenta previa complicated by placenta accreta.Methods: Seventy patients with abnormal fetal position admitted to our hospital from January 2019 to January 2020 were selected for the study. Patients were diagnosed by ultrasound alone, MRI alone, and ultrasound combined with MRI. Diagnostic accuracy, sensitivity, specificity and false positive and negative diagnosis rates were evaluated against the postoperative pathological examinations of the patients.Results: The diagnostic accuracy, sensitivity and false negative rate for ultrasound combined with MRI were 86.27%, 97.78% and 72.00%, respectively. These results were significantly superior to those of MRI or ultrasound alone (P<0.05). The specificity and false positive rate for ultrasound combined with MRI were 13.73% and 5.26%, respectively, which were not significantly different from those for MRI or ultrasound alone (P>0.05).Conclusions: Compared with ultrasound or MRI alone, ultrasound combined with MRI has higher accuracy and sensitivity in the diagnosis of placenta previa with placenta accreta, along with lower false positive diagnosis rates. These findings are clinically important for improving the diagnostic efficiency.

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Section: Discussionmentioning

confidence: 99%

Clinical diagnostic value and analysis of MRI combined with ultrasound in prenatal pernicious placenta previa with placenta accreta

Guo¹,

Wu²,

Yuan³

et al. 2021

Ann Palliat Med

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“…Although the etiology of post-uterine artery embolization syndrome remains unclear, uterine tissue ischemia may be the main cause of secondary inflammation [10] .The prenatal bleeding during labor induction was very rapid, which reached with 400 mL in a short time. In order to reduce complications of UAE and ensure the safety of pregnant women, prophylactic UAE can be adopted to treat high-risk bleeding for pregnant women with CPP combined with placenta accreta spectrum under the guidance of ultrasound and/or magnetic resonance imaging [12,13] .…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study on the Clinical Effect of Uterine Artery Embolization Combined with Cervical Double Balloon for Patients with Complete Placenta Previa Undergoing Pregnancy Termination in the Second Trimester

Peng

et al. 2021

Preprint

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Background Pregnancy termination in the second trimester is a complex and delicate situation for patients with complete placenta previa (CPP), which has less been reported. The objective of this research was to investigate and evaluate the clinical effect of uterine artery embolization(UAE) combined with cervical double balloon(CDB) for patients with CPP. Methods We conducted a retrospective study based on a large medical center. The medical records of patients who were diagnosed with CPP and treated UAE combined with CDB for termination in the second trimester in our hospital from January 2017 and March 2021 were retrospectively reviewed. The clinical outcomes were analyzed.Results A total of 11 patients with CPP were included in this study. Prenatal diagnosis of CPP was realized by trans-vaginal ultrasound. The average age was 34.2 years old, and the gestational week was 21.6 weeks. Of the selected patients, 3 cases (3/11) had previous caesarean delivery, 5 cases were at older maternal age (≥35 years old), 10 cases underwent emergency UAE for prenatal bleeding equal or up to 400 mL and 1 case underwent prophylactic UAE for placenta percreta, and all cases underwent CDB to promote cervical ripening. It was worth noting that 5 cases (5/11) of selected patients underwent curettage to take out fetus and placenta. The uterus preservation was achieved in all 11 patients. The complications associated with conservative management included prenatal hemorrhaging (10/11), blood transfusion (5/11), fever (2/11), and septicemia (1/11). The mean dilation of cervix was from 0cm to 1.9cm, the length of cervix was from 3.5cm to 0.6cm and the Bishop scores were from 1.5 to 7.3 after using CDB, the changes of cervical conditions were statistically significant (p＜0.05). The levels of WBC and CRP were higher after termination with medicine+UAE+CDB and/or curettage. Conclusion The adjuvant therapy of UAE, CDB, and/curettage step by step is a preferred choice for patients with CPP who underwent pregnancy termination in the second trimester.

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“…The included studies were prospectively conducted in 32 studies [9, 13-15, 18-22, 26-48] and retrospectively conducted in 17 studies [16,17,[23][24][25][49][50][51][52][53][54][55][56][57][58]. Two studies were a collection of prospective and retrospective design [12,59], and 3 studies were cross sectional [10,60,61].…”

Section: Study Characteristicsmentioning

confidence: 99%

Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis

Maged

El-Mazny

Kamal

et al. 2023

BMC Pregnancy Childbirth

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Objective To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS). Data sources Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis. Study eligibility criteria All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them. Study appraisal and synthesis methods Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity. Results The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively. Conclusions The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases. Trial registration Number CRD42021267501.

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The clinical utility of magnetic resonance imaging as an adjunct to ultrasound in the diagnosis of placenta accreta spectrum disorders

Cited by 3 publications

References 19 publications

Clinical diagnostic value and analysis of MRI combined with ultrasound in prenatal pernicious placenta previa with placenta accreta

Clinical diagnostic value and analysis of MRI combined with ultrasound in prenatal pernicious placenta previa with placenta accreta

A Retrospective Study on the Clinical Effect of Uterine Artery Embolization Combined with Cervical Double Balloon for Patients with Complete Placenta Previa Undergoing Pregnancy Termination in the Second Trimester

Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis

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