Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study.
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SUBMITTER: Fratelli N
PROVIDER: S-EPMC9544821 | biostudies-literature | 2022 Sep
REPOSITORIES: biostudies-literature
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Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study.
Fratelli N N Prefumo F F Maggi C C Cavalli C C Sciarrone A A Garofalo A A Viora E E Vergani P P Ornaghi S S Betti M M Vaglio Tessitore I I Cavaliere A F AF Buongiorno S S Vidiri A A Fabbri E E Ferrazzi E E Maggi V V Cetin I I Frusca T T Ghi T T Kaihura C C Di Pasquo E E Stampalija T T Belcaro C C Quadrifoglio M M Veneziano M M Mecacci F F Simeone S S Locatelli A A Consonni S S Chianchiano N N Labate F F Cromi A A Bertucci E E Facchinetti F F Fichera A A Granata D D D'Antonio F F Foti F F Avagliano L L Bulfamante G P GP Calì G G
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 20220901 3
<h4>Objective</h4>To evaluate the performance of third-trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low-lying placenta or placenta previa.<h4>Methods</h4>This was a prospective multicenter study of pregnant women aged ≥ 18 years who were diagnosed with low-lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at ≥ 26 + 0 weeks' gestation, between Octobe ...[more]
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Project description:BackgroundDisruptions in epigenetic mechanisms regulating placentation, particularly imbalances in the levels of small non-coding RNAs, contribute to various pregnancy complications, including preeclampsia (PE) and placenta accreta spectrum (PAS). Given that abnormal trophoblast differentiation, invasiveness, and angiogenesis-reduced in PE and excessive in PAS-are central to the pathogenesis of these conditions, this study aimed to identify universal circulating piRNAs and their targets.MethodsSmall RNA deep sequencing, quantitative reverse transcription combined with real-time polymerase chain reaction, magnetic bead-based multiplex immunoassay, ELISA, and Western blotting were employed to quantify circulating piRNAs and proteins in the blood serum of pregnant women during the 11th-14th weeks of gestation.ResultsStatistically significant negative correlations were identified between PE- and PAS-associated piRNAs (hsa_piR_019122, hsa_piR_020497, hsa_piR_019949, and piR_019675) and several molecules, including Endoglin, IL-18, VEGF-A, VEGF-C, Angiopoietin-2, sFASL, HB-EGF, TGFα, and Clusterin. These molecules are involved in processes such as angiogenesis, inflammation, the epithelial-mesenchymal transition, cell proliferation, adhesion, and apoptosis. A first-trimester pregnancy screening algorithm was developed using logistic regression models based on Clusterin concentration and the levels of hsa_piR_020497, hsa_piR_019949, piR_019675, and hsa_piR_019122.ConclusionsThe proposed screening tool for early pregnancy monitoring may enable the prediction of PE or PAS in the first trimester, allowing timely interventions to reduce maternal and perinatal morbidity and mortality.
| S-EPMC11852485 | biostudies-literature
Project description:Background Uterine incarceration is a rare obstetric complication that is always associated with retroversion and prone to misdiagnosis. Pelvic examination and imaging methods including ultrasound and magnetic resonance imaging (MRI) are used as the primary diagnostic tool. We present an asymptomatic anterior uterine incarceration complicated by placenta previa and placenta accreta spectrum (PAS) disorder, which could be diagnosed during the pregnancy periods, but was first diagnosed during the cesarean section (CS) and got the surgeons into trouble. Case Description A 28-year-old woman, gravidity 4, parity 1, was hospitalized due to placenta previa and PAS disorder diagnosed by ultrasound and MRI at 35.6 weeks of gestation. She had not experienced any discomfort. Given her history of a previous CS, she underwent a well-prepared cesarean delivery for the termination of the pregnancy. The patient had a series of periodical ultrasound and MRI examinations in which placenta previa and placenta accreta were described in disregard of the abnormal location of cervix; consequently, interior uterine incarceration was first diagnosed during the surgery, which caused significant difficulties in the operation which lasted 3 hours and 21 minutes. The patient developed severe hemorrhaging and lost approximately 5,000 mL of blood. Fortunately, she delivered a health male infant weighing 3,440 grams with quite good Apgar scores. During the follow-up, maternal and child health was confirmed. Conclusions With regard to patients who have undergone previous pelvic surgery, doctors need to pay close attention to the position of the cervix, the pelvic adhesion situation during the prenatal examination, and be on alert for uterine incarceration. Uterine incarceration can be accurately recognized by periodic sonography and MRI if the radiologist is aware of this unusual condition. We do suggest that special are must be taken to avoid unnecessary trauma by misdiagnosis because of lack of awareness.
| S-EPMC9929783 | biostudies-literature
Project description:ImportancePlacenta previa is widely acknowledged as a risk factor for placenta accreta spectrum (PAS) disorders, which are severe maternal complications; however, data are limited regarding whether placenta previa is associated with a higher risk of worse maternal outcomes among patients with PAS disorders.ObjectiveTo examine the association between placenta previa and the risk of severe maternal morbidities (SMMs) and higher resource use among patients with PAS disorders.Design, setting, and participantsThis retrospective cohort study extracted records of 3793 patients with PAS diagnosis and delivery indicators between October 1, 2015, and December 31, 2019, from the US National Inpatient Sample database.ExposuresPlacenta previa.Main outcomes and measuresData on 21 Centers for Disease Control and Prevention-defined SMMs and 25 study-defined surgical morbidities associated with PAS were extracted. Six surgical procedures (cystoscopy, intra-arterial balloon occlusion, cesarean delivery, hysterectomy, cystectomy, and oophorectomy), hospital length of stay, and inpatient costs were compared. Multivariable Poisson regression models built in the generalized estimating equation framework were used.ResultsAmong 3793 patients with PAS (median [IQR] age at admission, 33 [29-37] years), 621 women (16.4%) were Black, 765 (20.2%) were Hispanic, 1779 (46.9%) were White, 441 (11.6%) were of other races and/or ethnicities (47 [1.2%] were American Indian, 220 [5.8%] were Asian or Pacific Islander, and 174 [4.6%] were of multiple or other races and/or ethnicities), and 187 (4.9%) were of unknown race and ethnicity. A total of 1323 patients (34.9%) had placenta previa and 2470 patients (65.1%) did not; of those with placenta previa, 405 patients (30.6%) had invasive PAS. Patients with vs without placenta previa had a significantly higher rate and risk of any SMM (935 women [70.7%] vs 1087 women [44.0%]; P < .001; adjusted risk ratio [aRR], 1.19; 95% CI, 1.12-1.27) and any surgical morbidity (1170 women [88.4%] vs 1667 women [67.5%]; P < .001; aRR, 1.18; 95% CI, 1.13-1.23). With regard to specific outcomes, those with vs without placenta previa had a significantly higher rate of peripartum hemorrhage (878 patients [66.4%] vs 1217 patients [49.3%]; P < .001), blood product transfusion (413 patients [31.2%] vs 610 patients [24.7%]; P < .001), shock (83 patients [6.3%] vs 108 patients [4.4%]; P = .01), disseminated intravascular coagulation or other coagulopathy (77 patients [5.8%] vs 105 patients [4.3%]; P = .04), and urinary tract injury (44 patients [3.3%] vs 41 patients [1.7%]; P = .002). Patients with vs without placenta previa were more likely to undergo cesarean delivery (1292 patients [97.7%] vs 1787 patients [72.3%]; P < .001), hysterectomy (786 patients [59.4%] vs 689 patients [27.9%]; P < .001), cystoscopy (301 patients [22.8%] vs 203 patients [8.2%]; P < .001), cystectomy (157 patients [11.9%] vs 98 patients [4.0%]; P < .001), and intra-arterial balloon occlusion (121 patients [9.1%] vs 77 patients [3.1%]; P < .001) and to have significantly longer hospital length of stay (median [IQR], 5 [4-11] days vs 3 [3-5] days; P < .001) and total inpatient costs (median [IQR], $17 496 [$10 863-$30 619] vs $9728 [$6130-$16 790]; P < .001). Hypertensive disorder of pregnancy was associated with a decreased risk of placenta previa (aRR, 0.67; 95% CI, 0.46-0.96) among patients with PAS.Conclusions and relevanceIn this study, placenta previa was associated with an increased risk of maternal and surgical morbidities and higher resource use among women with PAS. These findings suggest that interventions to alleviate maternal and surgical morbidities are especially needed for patients with placenta previa-complicated PAS disorders.
| S-EPMC9396360 | biostudies-literature
Project description:ObjectiveTo assess the performance of the 'separation sign' as a predictor of normal placental separation in a large cohort of women at risk for placenta accreta spectrum (PAS) and in a high-risk subgroup with placenta previa or anterior low-lying placenta and at least one previous Cesarean delivery.MethodsThis was a prospective study of women at risk for PAS referred to a specialist clinic at between 22 and 38 weeks' gestation. All women underwent ultrasound assessment for the presence of the separation sign, which detects the difference in elasticity between the myometrium and the placenta, characterized by different rates of rebound after an ultrasound probe is used to apply pressure over the uteroplacental interface. When the sign is positive, the placenta appears to move relative to the myometrium, leading to the appearance or enhancement of the clear zone. The predictive performance of the separation sign for normal spontaneous placental separation at delivery was assessed.ResultsOf the 194 included women, 163 had a positive separation sign, all of whom went on to have normal placental separation at delivery. Of the 24 women with a negative separation sign, three (12.5%) had normal placental separation and 21 (87.5%) were diagnosed with PAS. This yielded a sensitivity of 98.2% (95% CI, 94.8-99.6%) and specificity of 100% (95% CI, 83.9-100%). In the high-risk cohort (n = 35), a positive separation sign remained a reliable predictor of normal placental separation, with a positive predictive value of 100%, sensitivity of 88.9% (95% CI, 65.3-98.6%) and specificity of 100% (95% CI, 80.5-100%).ConclusionsThe separation sign could be a useful tool in women considered to be at risk for PAS, as it can facilitate the prediction of normal placental separation at delivery. This may prevent overtreatment, the associated iatrogenic morbidity and unnecessary allocation of clinical resources. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
| S-EPMC9545572 | biostudies-literature
Project description:Objective To evaluate certain two-dimensional (2D) ultrasound signs as predictors of massive peri-operative blood loss (PBL) in pregnant women with placenta previa suspicious of PAS disorder. Materials and methods A single center retrospective study was done in pregnant women who had undergone prenatal diagnosis with 2D ultrasound grey scale and color Doppler using the EW-AIP (which has been changed to IS-PAS (International Society for the Placenta Accreta Spectrum)) criteria between January 2007 and May 2021. The patients were divided into 2 groups, non-massive hemorrhage with PBL ≤ 2500 mL and massive PBL >2500 mL. All PAS cases had pathological confirmation. Ultrasound signs and hemorrhagic outcomes were compared between the two groups. A PAS scoring system to predict massive PBL was constructed and a receiver operating characteristic (ROC) curve was calculated to evaluate the efficacy of the scoring system. Results Of 534 women, 146 (28.3%) had PBL > 2500 mL and 388 (71.7%) had PBL ≤ 2500 mL. In the massive PBL group, 101 (69.2%) were diagnosed as PAS and 45 (30.8%) as placenta previa alone. From 10 evaluated 2D ultrasound signs, 3 had the highest odds ratios (ORs) associated with massive PBL, ‘focal exophytic mass’ OR 8.17 (p = 0.024), ‘placental bulge’ OR 2.47 (p = 0.011), and ‘placental lacunae feeder vessels’ OR 2.38 (p = 0.01). When using the PAS scoring system, the AUC to predict massive PBL was 0.80 (95% CI, 0.76–0.85,). Conclusion Our PAS scoring system based on 2-dimensional ultrasound signs combined with grey scale and color Doppler is useful to predict massive PBL and can help optimize pre-operative management in cases of previa suspicious of PAS.
| S-EPMC9565412 | biostudies-literature
Project description:ObjectiveTo assess how a quantifiable measure of vascularity-i.e. abnormal confluence (Acon ) in the subplacental myometrium observed by three-dimensional power-Doppler ultrasonography-changes with different bladder volumes.MethodsIn a prospective observational study, women referred to a tertiary UK center with suspected PAS disorders were recruited between August 2016 and May 2017. The largest area of confluent three-dimensional power-Doppler signal (Acon ) at the uteroplacental interface was estimated under two bladder volumes differing by at least 200 mL.ResultsAcon was calculated for 14 women, of whom seven were subsequently found to have PAS disorders. For these seven women, log(Acon ) was significantly greater when measured with a filled bladder than when measured with an unfilled bladder (P<0.001).ConclusionObjective evidence was found for a quantifiable difference in vascularity in the myometrium with bladder volume among women with PAS disorders. This difference has sufficient magnitude to influence the potential of Acon as a diagnostic marker.
| S-EPMC6449684 | biostudies-literature
Project description:BackgroundMagnetic resonance imaging has been used increasingly as an adjunct for ultrasound imaging for placenta accreta spectrum assessment and preoperative surgical planning, but its value has not been established yet. The ultrasound-based placenta accreta index is a well-validated standardized approach for placenta accreta spectrum evaluation. Placenta accreta spectrum-magnetic resonance imaging markers have been outlined in a joint guideline from the Society of Abdominal Radiology and the European Society of Urogenital Radiology.ObjectiveThis study aimed to compare placenta accreta spectrum-magnetic resonance imaging parameters with the ultrasound-based placenta accreta index in pregnancies at high risk for placenta accreta spectrum and to assess the additional diagnostic value of magnetic resonance imaging for placenta accreta spectrum that requires a cesarean hysterectomy.Study designThis was a single-center, retrospective study of pregnant patients who underwent magnetic resonance imaging, in addition to ultrasonography, because of suspected placenta accreta spectrum. The ultrasound-based placenta accreta index and placenta accreta spectrum-magnetic resonance imaging parameters were obtained. Student's t test and Fisher's exact test were used to compare the groups in terms of the primary outcome (hysterectomy vs no hysterectomy). The diagnostic performance of magnetic resonance imaging and the ultrasound-based placenta accreta index was assessed using multivariable logistic regressions, receiver operating characteristics curves, the DeLong test, McNemar test, and the relative predictive value test.ResultsA total of 82 patients were included in the study, 41 of whom required a hysterectomy. All patients who underwent a hysterectomy met the International Federation of Gynecology and Obstetrics clinical evidence of placenta accreta spectrum at the time of delivery. Multiple parameters of the ultrasound-based placenta accreta index and placenta accreta spectrum-magnetic resonance imaging were able to predict hysterectomy, and the parameter of greatest dimension of invasion by magnetic resonance imaging was the best quantitative predictor. At 96% sensitivity for hysterectomy, the cutoff values were 3.5 for the ultrasound-based placenta accreta index and 2.5 cm for the greatest dimension of invasion by magnetic resonance imaging. Using this sensitivity, the parameter of greatest dimension of invasion measured by magnetic resonance imaging had higher specificity (P=.0016) and a higher positive predictive value (P=.0018) than the ultrasound-based placenta accreta index, indicating an improved diagnostic threshold.ConclusionIn a suspected high-risk group for placenta accreta spectrum, magnetic resonance imaging identified more patients who will not need a hysterectomy than when using the ultrasound-based placenta accrete index only. Magnetic resonance imaging has the potential to aid patient counseling, surgical planning, and delivery timing, including preterm delivery decisions for patients with placenta accreta spectrum requiring hysterectomy.
| S-EPMC11070455 | biostudies-literature
Project description:Placenta accreta spectrum (PAS) refers to excessive placental invasion into the maternal uterus and it is associated with high risk of obstetric haemorrhage and adverse maternal-neonatal outcomes. Currently, no specific circulating biomarkers of PAS have been identified. Given that in PAS disorders, the depth and the extension of placental invasion into the uterus are expected to be increased, in this study, we analysed plasma levels of syncytiotrophoblast-derived extracellular vesicles (STBEVs) in women with placenta previa (PP), at a high risk of PAS disorders, and pregnant women with normal placentation. Venous blood samples were collected from 35 women with ultrasonographic diagnosis of PP and 35 women with normal placentation, matched for gestational age. Plasma samples were ultracentrifuged at 120.000 g to collect extracellular vesicles (EVs). To identify and quantify plasma placenta-derived EVs (or STBEVs), EVs were analysed by flow cytometry using a monoclonal antibody against placental alkaline phosphatase (PLAP). Plasma levels of STBEVs were significantly higher in PP patients compared to controls. Plasma levels of STBEVs in women with PP and PAS showed a trend to a higher concentration compared to women with PP without PAS, although not reaching a statistical significance. Circulating STBEVs are potential candidates as biological markers to be integrated to ultrasonography in the antenatal screening programme for PAS. More studies are needed to confirm our observation in a larger cohort of patients and to analyse a possible association between high circulating levels of STBEVs and PAS.
| S-EPMC11217103 | biostudies-literature
Project description:Placentation disorders are the result of impaired embedding of the placenta in the endometrium. The prevalence of these disorders is estimated to be around 0.3 %. A history of previous prior uterine surgery (especially cesarean section and curettage) is the most common risk factor. Impaired placentation is differentiated into deep placental attachment; marginal, partial and total placenta previa; and placenta accreta, increta and percreta. Treatment depends on the severity of presentation and ranges from expectant management to emergency hysterectomy. In most cases, preterm termination of pregnancy is necessary. We report here on the case of a 39-year-old woman with placenta accreta and total placenta previa who underwent hysterectomy in the 19th week of pregnancy.
| S-EPMC4554505 | biostudies-literature
Project description:IntroductionIn cases of placenta accreta spectrum, a precise antenatal diagnosis of the suspected degree of invasion is essential for the planning of individual management strategies at delivery. The aim of this work was to evaluate the respective performances of ultrasonography and magnetic resonance imaging for the antenatal assessment of the severity of placenta accreta spectrum disorders included in the database. The secondary objective was to identify descriptors related to the severity of placenta accreta spectrum disorders.Material and methodsAll the cases included in the database for which antenatal imaging data were available were analyzed. The rates of occurrence of each ultrasound and magnetic resonance imaging descriptor were reported and compared between the Group "Accreta-Increta" (FIGO grades 1 & 2) and the Group "Percreta" (FIGO grade 3).ResultsAntenatal imaging data were available for 347 women (347/442, 78.5%), of which 105 were included in the Group "Accreta - Increta" (105/347, 30.2%) and 213 (213/347, 61.4%) in the Group "Percreta". Magnetic resonance imaging was performed in addition to ultrasound in 135 women (135/347, 38.9%). After adjustment for all ultrasound descriptors in multivariate analysis, only the presence of a bladder wall interruption was associated with a significant higher risk of percreta (Odds ratio 3.23, Confidence interval 1.33-7.79). No magnetic resonance imaging sign was significantly correlated with the degree of severity.ConclusionsThe performance of ultrasound and magnetic resonance imaging to discriminate mild from severe placenta accreta spectrum disorders is very poor. To date, the benefit of additional magnetic resonance imaging has not been demonstrated.
| S-EPMC8252006 | biostudies-literature