TY - JOUR
T1 - Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis
AU - Pagani, Giorgio
AU - Cali, Giuseppe
AU - Acharya, Ganesh
AU - Trisch, Ilan-Timor
AU - Palacios-Jaraquemada, Jose
AU - Familiari, Alessandra
AU - Buca, Danilo
AU - Manzoli, Lamberto
AU - Flacco, Maria E.
AU - Fanfani, Francesco
AU - Liberati, Marco
AU - Scambia, Giovanni
AU - D'Antonio, Francesco
PY - 2018
Y1 - 2018
N2 - Introduction: Our objective was to elucidate the overall diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation (AIP). Material and methods: Medline, Embase, CINAHL and The Cochrane databases were searched. The ultrasound signs explored were: loss of hypoechoic (clear) zone in the placentalâuterine interface, placental lacunae, bladder wall interruption, myometrial thinning, focal exophitic mass, placental lacunar flow, subplacental vascularity, and uterovesical hypervascularity. Results: Twenty studies (3209 pregnancies) were included. Ultrasound had an overall good diagnostic accuracy in identifying the depth of placental invasion with sensitivities of 90.6%, 93.0%, 89.5%, and 81.2% for placenta accreta, increta, accreta/increta, and percreta, respectively; the corresponding specificities were 97.1%, 98.4%, 94.7%, and 98.9%. Placental lacunae had sensitivities of 74.8%, 88.6%, and 76.3% for the detection of placenta accreta, increta, and percreta, respectively. Sensitivity and specificity of loss of the clear zone in identifying placenta accreta were 74.9% and 92.0%, whereas the corresponding figures for placenta increta and percreta were 91.6% and 76.9%, and 88.1% and 71.1%. Lacunar flow had sensitivities of 81.2%, 84.3%, and 45.2% for the detection of placenta accreta, increta, and percreta respectively; the corresponding figures for specificity were 84.0%, 79.7%, and 75.3%. Sensitivity of uterovesical hypervascularity was low for the detection of placenta accreta (12.3%) but high for placenta increta (94.4%) and percreta (86.2%); the corresponding figures for specificity were 90.8%, 88.0% and 88.2%, respectively. Conclusions: Ultrasound has an overall good diagnostic accuracy in recognizing the depth and the topography of placental invasion.
AB - Introduction: Our objective was to elucidate the overall diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation (AIP). Material and methods: Medline, Embase, CINAHL and The Cochrane databases were searched. The ultrasound signs explored were: loss of hypoechoic (clear) zone in the placentalâuterine interface, placental lacunae, bladder wall interruption, myometrial thinning, focal exophitic mass, placental lacunar flow, subplacental vascularity, and uterovesical hypervascularity. Results: Twenty studies (3209 pregnancies) were included. Ultrasound had an overall good diagnostic accuracy in identifying the depth of placental invasion with sensitivities of 90.6%, 93.0%, 89.5%, and 81.2% for placenta accreta, increta, accreta/increta, and percreta, respectively; the corresponding specificities were 97.1%, 98.4%, 94.7%, and 98.9%. Placental lacunae had sensitivities of 74.8%, 88.6%, and 76.3% for the detection of placenta accreta, increta, and percreta, respectively. Sensitivity and specificity of loss of the clear zone in identifying placenta accreta were 74.9% and 92.0%, whereas the corresponding figures for placenta increta and percreta were 91.6% and 76.9%, and 88.1% and 71.1%. Lacunar flow had sensitivities of 81.2%, 84.3%, and 45.2% for the detection of placenta accreta, increta, and percreta respectively; the corresponding figures for specificity were 84.0%, 79.7%, and 75.3%. Sensitivity of uterovesical hypervascularity was low for the detection of placenta accreta (12.3%) but high for placenta increta (94.4%) and percreta (86.2%); the corresponding figures for specificity were 90.8%, 88.0% and 88.2%, respectively. Conclusions: Ultrasound has an overall good diagnostic accuracy in recognizing the depth and the topography of placental invasion.
KW - Abnormally invasive placenta
KW - Female
KW - Humans
KW - Myometrium
KW - Obstetrics and Gynecology
KW - Placenta
KW - Placenta Accreta
KW - Pregnancy
KW - Sensitivity and Specificity
KW - Ultrasonography, Prenatal
KW - placenta accreta
KW - placenta increta
KW - placenta percreta
KW - prenatal diagnosis
KW - ultrasound
KW - Abnormally invasive placenta
KW - Female
KW - Humans
KW - Myometrium
KW - Obstetrics and Gynecology
KW - Placenta
KW - Placenta Accreta
KW - Pregnancy
KW - Sensitivity and Specificity
KW - Ultrasonography, Prenatal
KW - placenta accreta
KW - placenta increta
KW - placenta percreta
KW - prenatal diagnosis
KW - ultrasound
UR - http://hdl.handle.net/10807/111956
UR - http://obgyn.onlinelibrary.wiley.com/hub/journal/10.1111/(issn)1600-0412/issues/
U2 - 10.1111/aogs.13238
DO - 10.1111/aogs.13238
M3 - Article
SN - 0001-6349
VL - 97
SP - 25
EP - 37
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
ER -