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Effectiveness of contingent screening for placenta accreta spectrum disorders based on persistent low‐lying placenta and previous uterine surgery

Coutinho, CM; Giorgione, V; Noel, L; Liu, B; Chandraharan, E; Pryce, J; Frick, AP; Thilaganathan, B; Bhide, A (2021) Effectiveness of contingent screening for placenta accreta spectrum disorders based on persistent low‐lying placenta and previous uterine surgery. Ultrasound Obstet Gynecol, 57 (1). pp. 91-96. ISSN 1469-0705 https://doi.org/10.1002/uog.23100
SGUL Authors: Thilaganathan, Baskaran Bhide, Amarnath Chandraharan, Edwin

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Abstract

Objectives Maternal mortality related to placenta accreta spectrum (PAS) disorders remains substantial when diagnosed unexpectedly at delivery. The aim of this study was to evaluate the effectiveness of a routine contingent ultrasound screening program for PAS. Methods This was a retrospective study of data obtained between 2009 and 2019, involving two groups: a screening cohort of unselected women attending for routine mid‐trimester ultrasound assessment and a diagnostic cohort consisting of women referred to the PAS diagnostic service with a suspected diagnosis of PAS. In the screening cohort, women with a low‐lying placenta at the mid‐trimester assessment were followed up in the third trimester, and those with a persistent low‐lying placenta (i.e. placenta previa) and previous uterine surgery were referred to the PAS diagnostic service. Ultrasound assessment by the PAS diagnostic service consisted of two‐dimensional grayscale and color Doppler ultrasonography, and women with a diagnosis of PAS were usually managed with conservative myometrial resection. The final diagnosis of PAS was based on a combination of intraoperative clinical findings and histopathological examination of the surgical specimen. Results In total, 57 179 women underwent routine mid‐trimester fetal anatomy assessment, of whom 220 (0.4%) had a third‐trimester diagnosis of placenta previa. Seventy‐five of these women were referred to the PAS diagnostic service because of a history of uterine surgery, and 21 of 22 cases of PAS were diagnosed correctly (sensitivity, 95.45% (95% CI, 77.16–99.88%) and specificity, 100% (95% CI, 99.07–100%)). Univariate analysis demonstrated that parity ≥ 2 (odds ratio (OR), 35.50 (95% CI, 6.90–649.00)), two or more previous Cesarean sections (OR, 94.20 (95% CI, 22.00–656.00)) and placenta previa (OR, 20.50 (95% CI, 4.22–369.00)) were the strongest risk factors for PAS. In the diagnostic cohort, there were 173 referrals, with one false‐positive and three false‐negative diagnoses, resulting in a sensitivity of 96.63% (95% CI, 90.46–99.30%) and a specificity of 98.81% (95% CI, 93.54–99.97%). Conclusions A contingent screening strategy for PAS is both feasible and effective in a routine healthcare setting. When linked to a PAS diagnostic and surgical management service, adoption of such a screening strategy has the potential to reduce the maternal morbidity and mortality associated with this condition. However, larger prospective studies are necessary before implementing this screening strategy into routine clinical practice.

Item Type: Article
Additional Information: © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: Cesarean delivery, abnormally invasive placenta, diagnosis, low-lying placenta, placenta accreta, placenta previa, risk factors, screening, Placenta accreta, abnormally invasive placenta, cesarean delivery, diagnosis, low-lying placenta, placenta previa, risk factors, screening, Obstetrics & Reproductive Medicine, 1114 Paediatrics and Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
2 January 2021Published
31 August 2020Published Online
21 August 2020Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
2019/01280-3Fundação de Amparo à Pesquisa do Estado de São PauloUNSPECIFIED
765274H2020 Marie Skłodowska-Curie ActionsUNSPECIFIED
PubMed ID: 32865834
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112336
Publisher's version: https://doi.org/10.1002/uog.23100

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