Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence

Adu-Bredu, Theophilus K.; Ridwan, Robert; Aditiawarman, Aditiawarman; Ariani, Grace; Collins, Sally L.; Aryananda, Rozi A.

doi:10.1016/j.ajogmf.2024.101321

American Journal of Obstetrics & Gynecology MFM

2024

DOI: 10.1016/j.ajogmf.2024.101321

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Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence

Theophilus K. Adu-Bredu,

Robert Ridwan,

Aditiawarman Aditiawarman

et al.

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2024

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Cited by 3 publications

References 49 publications

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The role of MRI in "estimating" intraoperative bleeding during cesarean section for placenta accreta: a prospective cohort study

Zhang,

Li,

Jin

et al. 2024

Heliyon

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The role of MRI in "estimating" intraoperative bleeding during cesarean section for placenta accreta: a prospective cohort study

Zhang,

Li,

Jin

et al. 2024

Heliyon

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Accuracy of sonographic lower segment thickness and prediction of vaginal birth after caesarean in a resourced‐limited setting; Prospective study

Adu‐Takyi,

Munazzah,

Owusu

et al. 2024

BJOG

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ObjectivesTo assess the accuracy of ultrasound measurement of the lower uterine segment (LUS) thickness against findings at laparotomy, and to investigate its correlation with the success rate of vaginal birth after one previous caesarean delivery (CD) in a resource‐limited setting.DesignProspective study.SettingObstetrics and Gynaecology department in a tertiary hospital in Ghana.PopulationWomen with one previous CD undergoing either a trial of labour (TOLAC) or elective CD.MethodsMyometrial lower uterine segment thickness (mLUS) and full lower uterine segment thickness (fLUS) were measured with transvaginal ultrasound (TVUS). The women were managed according to local protocols with the clinicians blinded to the ultrasound measurements. The LUS was measured intraoperatively for comparison with ultrasound measurements.Main outcome measuresLower uterine segment findings at laparotomy, successful vaginal birth.ResultsA total of 311 pregnant women with one previous CD were enrolled; 147 women underwent elective CD and 164 women underwent a TOLAC. Of the women that underwent TOLAC, 96 (58.5%) women had a successful vaginal birth. The mLUS was comparable to the intraoperative measurement in the elective CD group with LUS thickness <5 mm (bias of 0.01, 95% CI −0.10 to 0.12 mm) whereas fLUS overestimated LUS <5 mm (bias of 0.93, 95% CI 0.80–1.06 mm). Successful vaginal birth rate correlated with increasing mLUS values (odds ratio 1.30, 95% CI 1.03–1.64). Twelve cases of uterine defect were recorded. LUS measurement ≤2.0 mm was associated with an increased risk of uterine defects with a sensitivity of 91.7% (95% CI 61.5–99.8%) and specificity of 81.8% (95% CI 75.8–86.8%).ConclusionAccurate TVUS measurement of the LUS is technically feasible in a resource‐limited setting. This approach could help in making safer decisions on mode of birth in limited‐resource settings.

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Differentiating placenta accreta spectrum from scar dehiscence with underlying, non‐adherent placenta: A systematic review of scoring systems and primary data analysis

Adu‐Bredu,

Aryananda,

Arkorful

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionAccurate discrimination between placenta accreta spectrum (PAS) and scar dehiscence with underlying non‐adherent placenta is challenging both on prenatal ultrasound and intraoperatively. This can lead to overdiagnosis of PAS and unnecessarily aggressive management of scar dehiscence which increases the risk of morbidity. Several scoring systems have been published which combine clinical and ultrasound information to help diagnose PAS in women at high risk. This research aims to provide insights into the reliability and utility of existing accreta scoring systems in differentiating these two closely related but different conditions to contribute to improved clinical decision making and patient outcomes.Material and MethodsA literature search was performed in four electronic databases. The references of relevant articles were also assessed. The articles were then evaluated according to the predefined inclusion criteria. Primary data for testing each scoring system were obtained retrospectively from two hospitals with specialized PAS services. Each scoring system was used to evaluate the predicted outcome of each case.ResultsThe literature review yielded 15 articles. Of these, eight did not have a clearly described diagnostic criteria for accreta, hence were excluded. Of the remaining seven studies, one was excluded due to unorthodox diagnostic criteria and two were excluded as they differed from the other systems hindering comparison. Four scoring systems were therefore tested with the primary data. All the scoring systems demonstrated higher scores for high‐grade PAS compared to scar dehiscence (p < 0.001) with an excellent Area Under the receiver operator characteristic Curve ranging from 0.82 (95% CI 0.71–0.92) to 0.87 (95% CI 0.79–0.96) in differentiating between these two conditions. However, no statistically significant differences were noted between the low‐grade PAS and scar dehiscence on all scoring systems.ConclusionsMost published scoring systems have no clearly defined diagnostic criteria. Scoring systems can differentiate between scar dehiscence with underlying non‐adherent placenta from high‐grade PAS with excellent diagnostic accuracy, but not for low‐grade PAS. Hence, relying solely on these scoring systems may lead to errors in estimating the risk or extent of the condition which hinders preoperative planning.

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Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence

Cited by 3 publications

References 49 publications

The role of MRI in "estimating" intraoperative bleeding during cesarean section for placenta accreta: a prospective cohort study

The role of MRI in "estimating" intraoperative bleeding during cesarean section for placenta accreta: a prospective cohort study

Accuracy of sonographic lower segment thickness and prediction of vaginal birth after caesarean in a resourced‐limited setting; Prospective study

Differentiating placenta accreta spectrum from scar dehiscence with underlying, non‐adherent placenta: A systematic review of scoring systems and primary data analysis

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