Accuracy of Prenatal Ultrasonography for Diagnosis of Placenta Accreta Spectrum and Risk Factors in A Tertiary Center in Southern Iran
One-year Placenta Accreta in Iran
DOI:
https://doi.org/10.31661/gmj.v13i.3316Keywords:
Placenta Accrete Spectrum; Palenta Previa; Cesarean Section; Outcome AssessmentAbstract
Background: Placenta accreta spectrum is one of the most important causes of massive bleeding in the peripartum period. The aim of this study was to determine the accuracy of prenatal ultrasonography for diagnosis of placenta accreta spectrum (PAS) and important risk factors of this pathology were evaluated in this report. Materials and Methods: This is a cross-sectional study conducted at Shiraz University of Medical Sciences during January 2018 to January 2019. All patients who were referred for ultrasound examination of placenta accrete spectrum and surgery in Hafez tertiary center were included. Patients with diagnosis of PAS in pathology were in one group and the others in the second group. All maternal and neonatal and demographic data and surgery complications were gathered in a data form. Results: Ultrasonography was 100% (95% C.I: 94.40%-100%) sensitive, 87.58% (95% C.I; 81.29%-92.36) specific, and 87.58% (95% C.I: 82.44%-91.66%) accurate discriminating PAS from non-PAS patients. From 217 patients, 64 and 153 patients were in PAS and non-PAS group, respectively. There was significantly more age, gravidity, live children, history of D&C, hormonal contraception, and history of previa in PAS group compared with Non-PAS group (p-value<0.05 for all); however, gestational age was significantly lower in PAS group (p-value<0.05). The odds of PAS significantly increase with previa and low-lying placenta OR adj (95% C.I): 114.68 (28.45-462.29). The patients with one C/S OR adj (95% C.I): 29.07(3.80-222.33) and the patients with two C/S OR adj (95% C.I): 106.08(13.79-815.51) were significantly more in PAS group compared with those with no C/S (p-value <0.05 for both). Conclusion: Detection rate of ultrasound examination was good, and it is recommended for women with PAS risk factors. Decreasing the rate of cesarean section and encouraging vaginal birth after cesarean section (VBAC) are the best ways of prevention of this pathology.
References
Belfort MA: Placenta accreta. American journal of obstetrics and gynecology 2010, 203(5):430-439.
Chantraine F, Langhoff-Roos J: Abnormally invasive placenta--AIP. Awareness and pro-active management is necessary. Acta obstetricia et gynecologica Scandinavica 2013, 92(4):369-371.
Jauniaux E, Bhide A: Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. American journal of obstetrics and gynecology 2017, 217(1):27-36.
Alanwar A, Al-Sayed HM: Urinary tract injuries during cesarean section in patients with morbid placental adherence: retrospective cohort study. 2019, 32(9):1461-1467.
Fan D, Li S, Wu S, Wang W, Ye S, Xia Q, Liu L, Feng J, Wu S, Guo X et al: Prevalence of abnormally invasive placenta among deliveries in mainland China: A PRISMA-compliant Systematic Review and Meta-analysis. Medicine 2017, 96(16):e6636.
Meng X, Xie L, Song W: Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: a systematic review and meta-analysis. Ultrasound in medicine & biology 2013, 39(11):1958-1965.
Pagani G, Cali G, Acharya G, Trisch IT, Palacios-Jaraquemada J, Familiari A: Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis. 2018, 97(1):25-37.
Familiari A, Liberati M, Lim P, Pagani G, Cali G, Buca D, Manzoli L, Flacco ME, Scambia G, D'Antonio F: Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta-analysis. Acta obstetricia et gynecologica Scandinavica 2018, 97(5):507-520.
Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadottir RI, Tapper AM, Bordahl PE, Gottvall K, Petersen KB et al: Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG : an international journal of obstetrics and gynaecology 2016, 123(8):1348-1355.
Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Dias S, Jones LV, Navaratnam K, Caldwell DM: Labour induction with prostaglandins: a systematic review and network meta-analysis. BMJ (Clinical research ed) 2015, 350:h217.
Javinani A, Qaderi S, Hessami K, Shainker SA, Shamshirsaz AA, Fox KA, Mustafa HJ, Subramaniam A, Khandelwal M, Sandlin AT et al: Delivery outcomes in the subsequent pregnancy following the conservative management of placenta accreta spectrum disorder: a systematic review and meta-analysis. American journal of obstetrics and gynecology 2023.
Kasraeian M, Hashemi A, Hessami K, Alamdarloo SM, Vahdani R, Vafaei H, Najib FS, Shiravani Z, Razavi B, Homayoon N: A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women. BMC Women's Health 2021, 21(1):1-6.
Marcellin L, Delorme P, Bonnet MP, Grange G, Kayem G, Tsatsaris V, Goffinet F: Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta. American journal of obstetrics and gynecology 2018, 219(2):193.e191-193.e199.
Farquhar CM, Li Z, Lensen S: Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study. 2017, 7(10):e017713.
Lyell DJ, Faucett AM, Baer RJ, Blumenfeld YJ, Druzin ML, El-Sayed YY, Shaw GM, Currier RJ, Jelliffe-Pawlowski LL: Maternal serum markers, characteristics and morbidly adherent placenta in women with previa. Journal of perinatology : official journal of the California Perinatal Association 2015, 35(8):570-574.
Büke B, Akkaya H, Demir S, Sağol S, Şimşek D, Başol G, Barutçuoğlu B: Relationship between first trimester aneuploidy screening test serum analytes and placenta accreta. The Journal of Maternal-Fetal & Neonatal Medicine 2018, 31(1):59-62.
Thompson O, Otigbah C, Nnochiri A, Sumithran E, Spencer K: First trimester maternal serum biochemical markers of aneuploidy in pregnancies with abnormally invasive placentation. BJOG : an international journal of obstetrics and gynaecology 2015, 122(10):1370-1376.
Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M: The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG : an international journal of obstetrics and gynaecology 2014, 121(1):62-70; discussion 70-61.
Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V: Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta obstetricia et gynecologica Scandinavica 2011, 90(10):1140-1146.
Shamshirsaz AA, Fox KA, Erfani H, Clark SL, Shamshirsaz AA, Nassr AA, Sundgren NC, Jones JA, Anderson ML, Kassir E et al: Outcomes of Planned Compared With Urgent Deliveries Using a Multidisciplinary Team Approach for Morbidly Adherent Placenta. Obstetrics & Gynecology 2018, 131(2):234-241.
Shamshirsaz AA, Fox KA, Salmanian B, Diaz-Arrastia CR, Lee W, Baker BW, Ballas J, Chen Q, Van Veen TR, Javadian P et al: Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. American journal of obstetrics and gynecology 2015, 212(2):218.e211-218.e219.
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Galen Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
